Heart rate of 90 beats per minute in hypertensive patients, is this normal? Stop ignoring the effect of heart rate on blood pressure

Both blood pressure and heart rate are important indicators of health assessment. Whether it is an increase in blood pressure or an increase in heart rate, both will increase the damage to the cardiovascular and cerebrovascular, and may increase the risk of acute cardiovascular and cerebrovascular events such as stroke and myocardial infarction.

So, the heart rate of hypertensive patients is 90 beats/min, is this normal?

The normal range of blood pressure and heart rate is the basic guarantee for life-sustaining activities. The blood pressure of healthy people should not be lower than 90/60mmHg, and should not be higher than 120/80mmHg; the heart rate should not be lower than 60 beats/min, and should not be higher than 100. times/min.

When blood pressure or heart rate exceeds the normal range, the greater the increase in blood pressure, the faster the rhythm of the heart beat, and the higher the probability of cardiovascular events in the future. Therefore, controlling blood pressure and heart rate within a reasonable range can benefit life. Although the normal range of heart rate is 60-100 beats/min, it cannot be used as a reference range for heart rate compliance in patients with hypertension.

There are two reasons:

First, increased heart rate itself can increase the incidence of hypertension

The increase of blood pressure is affected by many factors. The increase of the heart’s blood ejection volume, the increase of the peripheral vascular resistance, the weakening of the elastic reservoir of the aorta and the aorta, the increase of the circulating blood volume, and the acceleration of the heart rate can all increase the blood pressure. . Among them, the heart rate is not outside the normal range will have an impact on blood pressure, even if the heart rate in the normal range may increase the incidence of hypertension. A previous study in Japan found that people with a heart rate of more than 71 beats per minute had a 61% increase in the incidence of hypertension after 3 years compared with those with a heart rate of less than 58 beats per minute. Of course, the faster the heart rate, the greater the effect on blood pressure.

The effect of heart rate on blood pressure can also be confirmed from another group of people. People who are stressed or anxious for a long time have a significantly faster heart rate than the general population, and these patients have a higher chance of developing hypertension, usually with an increase in diastolic blood pressure. Mainly, blood pressure can also gradually decrease after treatment such as adjusting the mentality and slowing down the heart rate.

Second, increased heart rate can increase target organ damage in hypertension

Blood pressure is the pressure generated by blood acting on the side wall of the blood vessel. With the increase of blood pressure, the pressure on the blood vessel wall also increases, which is prone to atherosclerosis and plaque formation; when the heart rate increases, it can be further accelerated. The occurrence of atherosclerosis reduces the stability of plaque, increases the risk of plaque rupture, and is more likely to induce acute cardiovascular events such as stroke and myocardial infarction.

When hypertensive patients are complicated with coronary heart disease, the increased heart rate can increase myocardial oxygen consumption, which is not conducive to the control of coronary heart disease. Can cause kidney damage, increase microalbuminuria, combined with increased heart rate, albuminuria can be further aggravated. Therefore, hypertension and increased heart rate can synergistically damage target organs, increase cardiovascular events, and synergistically increase the risk of cardiovascular death. The management of heart rate in patients with hypertension should be more stringent.

So, what is the appropriate heart rate control for hypertensive patients?

A study on hypertension in China showed that when the heart rate was between 60 and 79 beats per minute, not only the average blood pressure level was the lowest, but also the blood pressure compliance rate was the highest. Of course, the premise of the research is to regulate and rationally treat hypertension. On this basis, controlling the heart rate within this range is more conducive to the control of blood pressure, and at the same time, it can reduce the damage to the target organs.

Therefore, there are two reference indicators for heart rate control in hypertensive patients: one is the resting heart rate, which is preferably controlled below 80 beats/min; the other is the average heart rate, which needs to be obtained through 24-hour dynamic heart rate monitoring to control it within 75 beats/min. /min or less is appropriate.

It should be noted that: the above heart rate control goals are for patients with simple hypertension combined with rapid heart rate. If they are combined with other diseases, reasonable control goals should be formulated according to the conditions:

① In patients with heart failure, if the left ventricular ejection fraction decreases, the heart rate should be controlled below 70 beats/min; if the left ventricular ejection fraction is preserved, the heart rate should not be controlled too low due to the reduced heart rate reserve.

② For patients with coronary heart disease, if it is myocardial infarction or unstable angina pectoris, the heart rate should be controlled at 50-60 beats/min; if it is chronic stable coronary heart disease, the heart rate should be controlled at 55-60 beats/min.

③ For patients with rapid atrial fibrillation, the ventricular rate should be controlled below 110 beats/min.

④ For patients with aortic dissection, the heart rate should be controlled at 50-60 beats/min.

Measures to slow the heart rate include non-drug therapy and drug therapy. In hypertensive patients with sedentary, obese, and metabolic disorders, the increased heart rate is related to sympathetic nerve excitation and insulin resistance. These patients can reduce the sympathetic effect by increasing exercise, losing weight, quitting smoking and limiting alcohol, and drinking less strong tea and coffee. At the same time of nerve activity, it can improve insulin resistance and help to slow down the heart rate. For patients whose heart rate is not up to the target by non-drug treatment, drugs should be actively selected to control the heart rate.