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Abstract
Heart rate is a key determinant of myocardial oxygen consumption. Several lines of
evidence support a consistent association between heart rate and cardiovascular mortality.
Increments in heart rate are positively related to cardiovascular and sudden death
in patients with hypertension or previous myocardial infarction and in the elderly
with heart disease. This relationship is important because a number of commonly used
cardiovascular agents, such as beta-blockers and calcium antagonists (CAs), can affect
heart rate. Beta-blockers decrease heart rate and reduce morbidity and mortality in
post-myocardial infarction patients. The CAs are a structurally diverse group of agents
with different physiologic effects. The dihydropyridine CAs are not associated with
a reduction in heart rate. In fact, often they can cause reflex tachycardia as a result
of potent systemic vasodilator action, which may provoke angina, especially in patients
with ischemic heart disease. The nondihydropyridine CAs verapamil and diltiazem reduce
heart rate but are associated with negative inotropy. Mibefradil, the first member
of a new class of CAs, reduces heart rate and is not associated with negative inotropic
effects. This unique pharmacologic profile may be of great value in treating hypertensive
patients, particularly those with coexisting ischemic heart disease, and also patients
with angina pectoris alone. However, the clinical benefit of pharmacologically reducing
heart rate with mibefradil needs to be demonstrated in controlled trials.
Keywords
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© 1997 Published by Elsevier Inc.
