tailieunhanh - Ebook Blood pressure monitoring in cardiovascular medicine and therapeutics: Part 2

(BQ) Part 2 book "Blood pressure monitoring in cardiovascular medicine and therapeutics" presents the following contents: Importance of heart rate in determining cardiovascular risk; sodium, potassium the sympathetic nervous system and the renin–angiotensin system - impact on the circadian variability in blood pressure; prognostic value of ambulatory blood pressure monitoring; circadian rhythm of myocardial infarction and sudden cardiac death;. | 7 Importance of Heart Rate in Determining Cardiovascular Risk Paolo Palatini MD Contents Introduction Epidemiologic Evidence Pathogenetic Considerations Looking for a Threshold Value Therapeutic Considerations References INTRODUCTION A body of evidence indicates that subjects with tachycardia are more likely to develop hypertension 1-3 and atherosclerosis in future years 4-6 . However the connection between heart rate and the cardiovascular risk has long been neglected on the grounds that tachycardia is often associated with the traditional risk factors for atherosclerosis such as hypertension or metabolic abnormalities 7 . A high heart rate is currently considered only an epiphenomenon of a complex clinical condition rather than an independent risk factor. However most epidemiogic studies showed that the predictive power of a fast heart rate for cardiovascular disease remains significant 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 that dealt with the relation between tachycardia and cardiovascular morbidity and mortality will be summarized and the pathogenesis of the connection between fast heart rate and cardiovascular disease will be the focus. From Contemporary Cardiology Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics Edited by W. B. White Humana Press Inc. Totowa NJ 159 160 Part II Circadian Variation in Cardiovascular Disease EPIDEMIOLOGIC EVIDENCE The heart rate was found to be a predictor for future development of hypertension as far back as in 1945 8 . This finding 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 1 2 9 . The heart rate was found to be also a predictor of myocardial infarction 10 11 and of cardiovascular morbidity in

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