The discussion in the symposium was mainly on two important aspects. One is whether the heart rate is considered while treating the patients with hypertension, and second, if it is considered, what is the most effective therapy in managing hypertension in patients with elevated heart rate.
Recent guidelines have indicated elevated heart rate as a potential factor of cardiovascular risk and may be a potential target of treatment. It is recommended that there should be heart rate measurement through the palpatory method after evaluating the blood pressure at each visit. Particular attention should be given to the patient with a heart rate above 80 beats per minute. Lowering the heart rate of patients on-treatment may have a low risk of organ damage and cardiovascular events.
Elevated heart rate also increases the risk of organ damage. It signifies why heart rate is extremely important and it is necessary to take the steps in its management in the clinical practice. Elevated heart rate increases all-cause mortality, CVD mortality, and CHD mortality. Various interventions may help in lowering the heart rate of hypertensive patients. These include pharmacological and non-pharmacological interventions. The use of beta-blockers in hypertensive patients may result in a reduction in heart failure, stroke, and coronary heart disease.
The speaker mentioned that there is a 50% reduction in the effectiveness of the treatment due to non-adherence and non-persistence and thus, there is poor control of blood pressure in such patients. Single-pill combination helps in more patient’s adherence as compared to free-equivalent combination (FEC). It is thus important that the patients should be treated with single-pill combinations wherever possible. Beta-blockers help in reducing heart rate, blood pressure, and improves the outcome of hypertensive patients, even those who are at high risk of complications such as patients with CHF, diabetes, and CAD. RAAS inhibitors may also be added to Beta-blockers. Among RAAS inhibitors, ACE inhibitors should be preferred over ARBs as first-line therapy.