Reappraisal of the importance of heart rate as a risk factor for cardiovascular morbidity and mortality

1997 ◽  
Vol 19 ◽  
pp. 39-52 ◽  
Author(s):  
Gabriel Habib
2008 ◽  
Vol 295 (2) ◽  
pp. H632-H639 ◽  
Author(s):  
Chao-Yin Chen ◽  
Drin Chow ◽  
Nipavan Chiamvimonvat ◽  
Kathryn A. Glatter ◽  
Ning Li ◽  
...  

Exposure to secondhand smoke (SHS), a major indoor air pollutant, is linked to increased cardiovascular morbidity and mortality, including cardiac arrhythmias. However, the mechanisms underlying the epidemiological findings are not well understood. Impaired cardiac autonomic function, indexed by reduced heart rate variability (HRV), may represent an underlying cause. The present study takes advantage of well-defined short-term SHS exposure (3 days, 6 h/day) on HRV and the susceptibility to arrhythmia in mice. With the use of electrocardiograph telemetry recordings in conscious mice, HRV parameters in the time domain were measured during the night after each day of exposure and 24 h after 3 days of exposure to either SHS or filtered air. The susceptibility to arrhythmia was determined after 3 days of exposure. Exposure to a low concentration of SHS [total suspended particle (TSP), 2.4 ± 3.2; and nicotine, 0.3 ± 0.1 mg/m3] had no significant effect on HRV parameters. In contrast, the exposure to a higher but still environmentally relevant concentration of SHS (TSP, 30 ± 1; and nicotine, 5 ± 1 mg/m3) significantly reduced HRV starting after the first day of exposure and continuing 24 h after the last day of exposure. Moreover, the exposed mice showed a significant increase in ventricular arrhythmia susceptibility and atrioventricular block. The data suggest that SHS exposure decreased HRV beyond the exposure period and was associated with an increase in arrhythmia susceptibility. The data provide insights into possible mechanisms underlying documented increases in cardiovascular morbidity and mortality in humans exposed to SHS.


2018 ◽  
Vol 146 (5-6) ◽  
pp. 330-337
Author(s):  
Branislava Ivanovic ◽  
Milan Pavlovic ◽  
Arsen Ristic ◽  
Dragan Kovacevic

Beta-blockers showed better results in lowering elevated blood pressure in the younger age group of patients with higher renin plasma levels. Actual recommendations from the European Society of Cardiology for treatment of arterial hypertension from 2013 insist that heart rate should always be measured along with blood pressure. These recommendations point out the significance of resting heart rate as an independent predictor of cardiovascular morbidity and mortality in patients with arterial hypertension. Beta-blockers have a compelling indication for treatment of arterial hypertension in patients with coexistence of coronary artery disease, especially post myocardial infarction, as well as in patients with systolic heart failure. Bisoprolol, a highly selective beta-blocker with a long half-life and a prolonged antihypertensive effect, has shown consistent blood pressure control over a period of 24 hours. It has been demonstrated in placebo-controlled studies that administration of thiazide diuretics, in addition to lowering blood pressure levels, had also been associated with a reduction of cardiovascular morbidity and mortality rates. It is evident that effectiveness of thiazide diuretics is dose-dependent; however, undesirable effects of drugs are also dose-dependent. Depending on the dose, they aggravate glucose intolerance, increase lipid levels, cause hypokalemia, hyponatremia, and hypomagnesemia, and increase levels of uric acid. Administration of very low doses of a thiazide diuretic is acceptable in combination with other antihypertensive drugs, because it potentiates the action of other drugs without causing undesirable metabolic effects. The effectiveness and safety of the combination of bisoprolol (in various doses) and a thiazide diuretic in a small dose has been proven in clinical trials.


2014 ◽  
Vol 26 (1) ◽  
pp. 56-62
Author(s):  
Sheikh Salahuddin Ahmed ◽  
Md Abu Saleh Mohammad Rizwan ◽  
Md Abdul Mahid Khan ◽  
Tarafdar Runa Laila ◽  
Md Abdul Hafez

Diabetic kidney disease (DKD) is a progressive condition and is an important cause of end stage renal disease (ESRD) as well as a risk factor for cardiovascular morbidity and mortality. This paper reviews various evidence based clinical guidelines, scientific papers and research studies on early detection and treatment of DKD. Microalbuminuria describes the urinary excretion of small amounts of albumin which identifies the early stage of DKD. In addition to an earliest marker of kidney damage, microalbuminuria is an established high risk factor for cardiovascular morbidity and mortality. Patients with microalbuminuria who progress to macroalbuminuria are likely to progress to ESRD. However effective treatment in the early stage of DKD reduces the risk and slows the progression of kidney damage. There is general agreement that people with diabetes should be screened regularly to detect early markers of kidney damage. People with diabetes and microalbuminuria should be treated with a multifactorial intervention approach to retard the progression of DKD. Studies have clearly demonstrated that the use of angiotensin converting enzyme inhibitors or angiotensin 2 receptor blockers with improved glycemic control, hypertension control, lipid lowering, aspirin use, smoking cessation, exercise programs and dietary intervention reduced the development of overt nephropathy and ESRD. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21317 Medicine Today 2014 Vol.26(1): 56-62


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