Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
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Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
Importance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2 Looking for a Tiiriỉsiioi.d Value Therapeutic Considerations ReferencesINTRODUCTIONA body of evidence indicates that subjects with tachycardia are more likely to develop hypertension (Ĩ—3) and atherosclerosis in future years (4-6). However. the connection between heart rale and the cardiovascular r Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2isk has long been neglected, on the grounds that tachycardia is often associated with the traditional risk factors for atherosclerosis, such as hypertEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
ension or metabolic abnormalities (7). A high heart rate is currently considered only an epiphenomcnon of a complex clinical condition rather than an Importance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2gnificant even when its relative risk is adjusted for all major risk factors for atherosclerosis and other confounders (4-7). In this chapter, the results of the main studies (hat dealt with the relation between tachycardia and cardiovascular morbidity and mortality will be summarized, and the patho Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2genesis of the connection between fast heart rate and cardiovascular disease will be the focus.From: Contemporary Cardiology:Blood Pressure MonitoringEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
in Cardiovascular Medicine and TherapeuticsEdited by: w. B. White © Humana Press Inc.. Totowa. NJ159160Part II / Circadian Variation in CardiovasculaImportance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2ing was subsequently confirmed by the Framingham study, in which the predictive power of the heart rate for future development of hypertension was similar to that of obesity (3). Several other more recent reports have confirmed those findings (7,2,9). The heart rale was found to be also a predictor Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2of myocardial infarction (10.11) and of cardiovascular morbidity in general (5.8). A body of evidence indicates that tachycardia is also related to inEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
creased risk of cardiovascular mortality. This association was shown by Levy el al. in a survey of over 20.000 Army officers (8). Thereafter, a numberImportance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2lar causes (4.5,6,12-15). The data related to sudden death were particularly impressive, especially in the Framingham study, in which a sharp upward trend in mortality was found in the men divided by quintiles of heart rale (6). Also, in the Chicago studies a strong association was found between hea Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2rt rate and sudden death, but the relation was U-shaped. because of an excess of mortality also in the subjects with very low heart rales (4).The relaEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
tionship between heart rale and cardiovascular mortality persists into old age. This was shown by the Framingham (6.16) and the NUANES (5) studies perImportance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2f heart rale for mortality was 1.38 for the men with a heart rale > 80 beals/minule (bpm) (lop quintile) compared to those of the three intermediate quintiles, and 0.82 for the men with a heart rate < 60 bpm (bottom quintile). The relation between heart rate and mortality was particularly strong for Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2 sudden death, with an adjusted relative risk of 2.45 for the subjects in the lop quintile as compared to those in the three intermediate quintiles. IEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
n the CASTEL study, no significant association between heart rate and mortality was found in the women. In another study performed on elderly men and Importance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2of 5 bpm of heart rale recorded over the 24 h.In the Framingham study, the relationship of heart rate with morbidity and mortality was analyzed also within hypertensive individuals (15) followed up for 36 yr. For a heart rale increment of 40 bpm the age-adjusted and systolic-blood-pressure-adj usled Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2 relative risk for cardiovascular mortality was 1.68 in males and 1.70 in females. For sudden death, the adjusted odds ratios were 1.93 and 1.37. respEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
ectively. These relationships were still significant after adjusting for smoking, total cholesterol, and left ventricular hypertrophy.The heart rate wImportance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2 Timolol Multicenter Study (17) and in a study by Hjalmarson et al.Fig. 1. Relative risks (RR) and 95% confidence limits (CL) for 1 -yr mortality in 250 men divided accordi ng to whether their heart rate was < 80 bpm or© 80 bpm on the seventh day after admission to the hospital for acute myocardial Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2infarction. Unadj = unadjusted relative risk: age-adj = relative risk adjusted for age: risk-adj = relative risks adjusted for age. CK-MB peak, echocaEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
rdiographic left ventricularcjcction fraction, diabetes, history of hypertension. current smoking, history ol angina. Killip class, thrombolysis and |Importance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2ion heart rate < 60 bpm. 41 % in the subjects with a heart rate > 90 bpm. and 48% in those with a heart rale >110 bpm. In a subsequent study. Disegni et al. found a doubled mortality risk in postmyocardial infarction patients with a heart rale > 90 bpm compared to subjects with a heart rate < 70 bpm Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2 (19). Two analyses performed in larger datasets confirmed the results of the above studies. In the GUSTO study (20), a high heart rate emerged as a pEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
otent precursor of mortality, and in the G1SS1-2 trial (27). the predischarge heart rale was a stronger predictor of death than standard indices of riImportance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2s cannot be considered simply as a marker of heart failure, as its predictive power appeared more evident in the subjects with no or mild signs of congestive heart failure (18,19). In a recent study, we found that the predictive power of heart rate for mortality in subjects with acute myocardial inf Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2arction remained significant also after adjusting for numerous confounders, including clinical and echocardiographic signs of left ventricular dysfuncEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
tion (Palatini et al., unpublished observations) (Fig. 1).PATHOGENETIC CONSIDERATIONSThe pathogenetic connection between fast heart rate and cardiovasImportance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2g. 2. Mechanisms of the connection between heart rale and cardiovascular morbidity and mortality. The heart rate can be a marker of risk' or a consequence of an underlying disease, but can exert a direct action in the induction of the risk as well. LV = left ventricular; BP = blood pressure. " = inc Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2reased. ) = decreased.rate can be considered as a marker of an underlying clinical condition related to the risk or a consequence of a latent chronicEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
disease. However, experimental evidence suggests that a high heart rate should be regarded as a pathogenetic factor in the induction of the risk as weImportance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic Considerations Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2and distensibility (23). Moreover, the mean bloodChapter 7 / Heart Rate and Cardiovascular Risk163Tabic 1Correlation Coefficients Between Resting Heart Rate and Other Clinical Variables in Three General and One Hypertensive PopulationsPopulationSBPDBPBMỈCTTGGLINSGeneralTecumseh0.270.260.110.160.13NS Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 20.19Mirano0.220.24NS0.050.08.20*—Belgian0.20.320.13NSNS.19*0.2HypertensiveHarvest0.260.1NSNSNSNS—SBP=systolic blood pressure: DBP = diastolic blood prEbook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2
essure: BMI = body mass index: CT = total cholesterol: TG = triglycerides: GL = glucose: INS = lasting insulin: NS = coefficient non significant: * = Importance of Heart Rate in Determining Cardiovascular RiskPaolo Palatini, ML)ContentsIntroduction Epidemiologic Evidence Pathogenetic ConsiderationsGọi ngay
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