Nowadays, as a common chronic disease, the incidence of hypertension is increasing. For the treatment of hypertension, patients usually focus most of their energy on measuring blood pressure, adjusting antihypertensive drugs, and controlling their diet, but pay less attention to heart rate. Many patients think that as long as their blood pressure is within the normal range, they don't need to worry about anything else. But in reality, changes in heart rate are closely related to the development of hypertension and the risk of cardiovascular events.
1. The importance of heart rate
Heart rate refers to the number of times the heart beats per minute. A normal adult's heart rate generally ranges from 60 to 100 beats per minute. For people with high blood pressure, an increased heart rate can mean a greater burden on the cardiovascular system.
First, an increased heart rate increases the heart's oxygen consumption. When the heart beats too fast, the heart needs to work harder to meet the body's blood supply needs, which causes the heart to consume more oxygen. Long-term high heart rate can cause fatigue, which may lead to cardiovascular diseases such as myocardial ischemia and angina.
Second, increased heart rate is strongly associated with increased blood pressure. Studies have shown that for every 10 beats per minute increase in heart rate, blood pressure may increase by 8-10mmHg. This is because an increased heart rate leads to an increase in cardiac output, which increases the pressure in the peripheral blood vessels. Therefore, controlling the heart rate can not only reduce the burden on the heart for people with high blood pressure, but also help lower blood pressure.
In addition, heart rate is also one of the important indicators to assess the risk of cardiovascular disease. A number of clinical studies have found that patients with hypertension who have a fast heart rate have a significantly higher risk of cardiovascular events (such as myocardial infarction, stroke, etc.) than patients with a normal heart rate.
2. What are the drugs to control heart rate?
For this reason, heart rate control is also key to preventing cardiovascular complications for people with high blood pressure. Moreover, patients with high blood pressure have a higher requirement to achieve the heart rate, which should be reduced to at least 75 beats per minute, and it is best to control it below 60 beats per minute. As for how to control the heart rate, the simplest and most effective way is drug treatment, and the drugs commonly used in clinical practice to control the heart rate mainly include the following categories.
1. β Receptor blockers: These drugs reduce the heart's oxygen consumption by blocking the heart's β receptors, slowing the heart rate and reducing myocardial contractility. Common β blockers are metoprolol, bisoprolol, atenolol, etc.
2. Non-dihydropyridine calcium channel blockers: These drugs mainly slow down the heart rate, reduce myocardial contractility, and dilate blood vessels by blocking the calcium channels of cardiomyocytes and vascular smooth muscle cells. Common non-dihydropyridine calcium channel blockers are verapamil and diltiazem.
3. Ivabradine: This is a new type of heart rate control drug that slows the heart rate by selectively inhibiting the pacing currents in the sinus node. Ivabradine is indicated primarily in patients with contraindications to or intolerant β-blockers, and in patients with heart failure with poorly controlled heart rate.
For patients with high blood pressure, the preferred heart rate-lowering drug is β receptor blocker, which is commonly used metoprolol, because this kind of drug can not only lower the heart rate, but also lower blood pressure, which can be said to be a multi-purpose drug, especially for hypertensive patients with fast heart rate. Speaking of which, some patients may also have questions, can the drug be stopped after taking metoprolol and the heart rate has returned to normal? Or do you want to stick to it for a long time?
3. Should I keep taking the medicine to control my heart rate, or should I stop taking it when I return to normal?
Whether people with high blood pressure can stop taking drugs to control their heart rate depends on the situation.
1. If the patient's heart rate is only temporarily elevated, such as when the heart rate increases during emotional agitation, strenuous exercise, etc., then the heart rate may return to normal after the triggers are removed. In this case, long-term medications to control the heart rate are generally not needed.
2. If the heart rate of a hypertensive patient is persistently higher than the normal range and cannot be effectively reduced after lifestyle interventions (such as appropriate exercise, weight loss, avoiding mental stress, etc.), then long-term medication to control the heart rate is required.
This is because increased heart rate is often a persistent pathological condition that is difficult to completely correct with lifestyle interventions alone. Moreover, a long-term increase in heart rate can cause ongoing damage to the heart and blood vessels, which in turn increases the risk of cardiovascular events. Therefore, for these patients, drugs to control the heart rate usually need to be taken for a long time to keep the heart rate within the normal range.
3. For patients with some special conditions, such as hypertensive patients with cardiovascular diseases such as coronary heart disease and heart failure, drugs to control heart rate may need to be taken more strictly for a long time. This is because the heart function of these patients is already impaired, and the increased heart rate can further burden the heart and increase the risk of the condition worsening. For example, in patients with coronary heart disease, heart rate control at 55-60 beats per minute can reduce myocardial oxygen consumption and reduce angina attacks; For people with heart failure, keeping a heart rate below 70 beats per minute can improve heart function and improve quality of life.
4. If hypertensive patients take metoprolol not only to lower the heart rate, but also as a blood pressure drug, it should not be stopped without authorization, otherwise it may lead to a rebound increase in blood pressure and heart rate, which brings danger. In addition, it is important to note that metoprolol cannot be stopped abruptly, there must be a gradual process, and it can be gradually stopped over a period of 1 week.
In short, in clinical practice, doctors usually formulate individualized treatment plans based on the specific situation of the patient, taking into account factors such as blood pressure, heart rate, and cardiovascular disease risk factors. At the same time, the doctor will also closely monitor the patient's condition and adjust the dose or type of medication in time according to the control of the heart rate.