Abstract
Objective
Heart rate has been shown to predict cardiovascular morbidity and mortality in a very reliable and easily accessible manner. The exact definition of the conditions under which heart rate is measured appears to be as crucial as the determinations of blood pressure or plasma catecholamines. It was investigated how accurately heart rate measurements were performed, and conditions were described in 56 studies identified from prominent journals within the Medline database: (a) search phrases were “heart rate” and “rest” or “resting”; (b) publication date was from 1996 to 2001; and (c) publication type was “clinical trial”.
Methods
Five conditions were considered as most influential: (a) resting period before measurement; (b) posture of the patient; (c) environmental conditions such as temperature or visual and acoustic stimuli; (d) method used to record heart rate; and (e) data analysis, i.e., derivation from raw data. An average of only 1.7 of those 5 criteria for the determination of heart rate were met in the studies included. Information on conditions of, for example, resting period, or environmental conditions is almost completely lacking.
Results and conclusion
The data show that a very important risk predictor and treatment target—heart rate—is not reported in a scientifically sufficient manner, even in large trials. Valuable information is lost despite the fact that the investment of adequately defining, controlling, and performing this determination is modest in comparison to the potential gain. It is recommended to standardize heart rate measurements in analogy to that of blood pressure determinations.
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References
Seccareccia F, Pannozzo F, Dima F, Minoprio A et al (2001) Malattie Cardiovascolari. Aterosclerotiche Istituto Superiore di Sanita Project. Heart rate as a predictor of mortality: the MATISS project. Am J Public Health 91:1258–1263
Reunanen A, Karjalainen J, Ristola P, Heliovaara M, Knekt P, Aromaa A (2000) Heart rate and mortality. J Int Med 247:231–239
Palatini P, Julius S (1999) The physiological determinants and risk correlation of elevated heart rate. Am J Hypertens 12:3S–8S
Northcote RJ, Ballantyne D (1993) Beta-adrenoceptor blockade and intrinsic sympathomimetic activity—relevance in the treatment of ischaemic heart disease. Scott Med J 30:205–215
Christ M, Wehling M (1998) Betablocking agents in patients with coronary artery disease and myocardial infarction. In: Böhm M, Laragh J, Zehender P (eds) From hypertension to heart failure. Springer, Berlin Heidelberg New York, pp 90–129
Levine HJ (1997) Rest heart rate and life expectancy. J Am Coll Cardiol 30:1104–1106
Poole-Wilson PA, Cleland JG, Di Lenarda A et al (2002) Rationale and design of the carvedilol or metoprolol European trial in patients with chronic heart failure: COMET. Eur J Heart Fail 4:321–329
Thomas L (2000) Labor und diagnose, textbook, 5th edn. Th-Books, Frankfurt
National Institutes of Health (1997) The sixth report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure. National Institutes of Health. National Heart, Lung and Blood Institute, National High Blood Pressure Education Program. NIH Publication, November 1997: No 98-4080
Bergfeldt L, Melander H, Schenck-Gustafsson K (1991) Time-dependent variation in the cardiac conduction system assessed in young healthy individuals at weeks’ interval: implications for clinical trials. J Am Coll Cardiol 18:792–800
Acknowledgements
This work was supported by: Federal Ministry of Education and Research, GFEC01166199–01EC0002.
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The experiments comply with the current laws of the country in which they were performed, inclusive of ethics approval.
List of papers included in the survey
List of papers included in the survey
1. Abramson BL, Ando S, Notarius CF, Rongen GA, Floras JS (1999) Effect of atrial natriuretic peptide on muscle sympathetic activity and its reflex control in human heart failure. Circulation 99:1810–1815
2. Accurso V, Winnicki M, Shamsuzzaman AS, Wenzel A, Johnson AK, Somers VK (2001) Predisposition to vasovagal syncope in subjects with blood/injury phobia. Circulation 104:903–907
3. Adachi H, Koike A, Obayashi T, Umezawa S, Aonuma K, Inada M, Korenaga M, Niwa A, Marumo F, Hiroe M (1996) Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J 17:1511–1521
4. Agewall S, Wright S, Doughty RN, Whalley GA, Duxbury M, Sharpe N (2000) Does a glass of red wine improve endothelial function? Eur Heart J 21:74–78
5. Bartels GL, Remme WJ, Holwerda KJ, Kruijssen DA (1996) Anti-ischaemic efficacy of L-propionylcarnitine—a promising novel metabolic approach to ischaemia? Eur Heart J 17:414–420
6. Becker LC, Pepine CJ, Bonsall R, Cohen JD, Goldberg AD, Coghlan C, Stone PH, Forman S, Knatterud G, Sheps DS, Kaufmann PG (1996) Left ventricular, peripheral vascular, and neurohumoral responses to mental stress in normal middle-aged men and women. Reference group for the psychophysiological investigations of myocardial ischemia (PIMI) study. Circulation 94:2768–2777
7. Bertolet BD, Anand IS, Bryg RJ, Mohanty PK, Chatterjee K, Cohn JN, Khurmi NS, Pepine CJ (1996) Effects of A1 adenosine receptor agonism using N6-cyclohexyl-2′-O-methyladenosine in patients with left ventricular dysfunction. Circulation 94:1212–1215
8. Botker HE, Sonne HS, Schmitz O, Nielsen TT (1998) Effects of doxazosin on exercise-induced angina pectoris, ST-segment depression, and insulin sensitivity in patients with syndrome X. Am J Cardiol 82:1352–1356
9. Boushel R, Calbet JA, Radegran G, Sondergaard H, Wagner PD, Saltin B (2001) Parasympathetic neural activity accounts for the lowering of exercise heart rate at high altitude. Circulation 104:1785–1791
10. Bowers TR, Stewart RE, O’Neill WW, Reddy VM, Safian RD (1997) Effect of rotablator atherectomy and adjunctive balloon angioplasty on coronary blood flow. Circulation 95:1157–1164
11. Brignole M, Menozzi C, Gianfranchi L, Musso G, Mureddu R, Bottoni N, Lolli G (1998) Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized, controlled study. Circulation 98:953–960
12. Buus NH, Bottcher M, Hermansen F, Sander M, Nielsen TT, Mulvany MJ (2001) Influence of nitric oxide synthase and adrenergic inhibition on adenosine-induced myocardial hyperemia. Circulation 104:2305–2310
13. Clarkson PB, Wheeldon NM, MacFadyen RJ, Pringle SD, MacDonald TM (1996) Effects of brain natriuretic peptide on exercise hemodynamics and neurohormones in isolated diastolic heart failure. Circulation 93:2037–2042
14. Demolis JL, Funck-Brentano C, Ropers J, Ghadanfar M, Nichols DJ, Jaillon P (1996) Influence of dofetilide on QT-interval duration and dispersion at various heart rates during exercise in humans. Circulation 94:1592–1599
15. Dunselman P, Liem AH, Verdel G, Kragten H, Bosma A, Bernink P (1997) Addition of felodipine to metoprolol vs replacement of metoprolol by felodipine in patients with angina pectoris despite adequate beta-blockade. Results of the felodipine er and metoprolol CR in angina (FEMINA) study. Working group on cardiovascular research, The Netherlands (WCN). Eur Heart J 18:1755–1764
16. Eriksson BE, Jansson E, Kaijser L, Sylven C (1999) Impaired exercise performance but normal skeletal muscle characteristics in female syndrome X patients. Am J Cardiol 84:176–180
17. Fadel PJ, Stromstad M, Hansen J, Sander M, Horn K, Ogoh S, Smith ML, Secher NH, Raven PB (2001) Arterial baroreflex control of sympathetic nerve activity during acute hypotension: effect of fitness. Am J Physiol Heart Circ Physiol 280:H2524–H2532
18. Fernhall B, Szymanski LM, Gorman PA, Kamimori GH, Kessler CM (2000) Both atenolol and propranolol blunt the fibrinolytic response to exercise but not resting fibrinolytic potential. Am J Cardiol 86:1398–1400
19. Figulla HR, Gietzen F, Zeymer U, Raiber M, Hegselmann J, Soballa R, Hilgers R (1996) Diltiazem improves cardiac function and exercise capacity in patients with idiopathic dilated cardiomyopathy. Results of the diltiazem in dilated cardiomyopathy trial. Circulation 94:346–352
20. Galcera-Tomas J, Castillo-Soria FJ, Villegas-Garcia MM, Florenciano-Sanchez R, Sanchez-Villanueva JG, de La Rosa JA, Martinez-Caballero A, Valenti-Aldeguer JA, Jara-Perez P, Parraga-Ramirez M, Lopez-Martinez I, Inigo-Garcia L, Pico-Aracil F (2001) Effects of early use of atenolol or captopril on infarct size and ventricular volume: a double-blind comparison in patients with anterior acute myocardial infarction. Circulation 103:813–819
21. Givertz MM, Hartley LH, Colucci WS (1997) Long-term sequential changes in exercise capacity and chronotropic responsiveness after cardiac transplantation. Circulation 96:232–237
22. Glasser SP, Michie DD, Thadani U, Baiker WM (1997) Effects of zatebradine (ULFS 49 CL), a sinus node inhibitor, on heart rate and exercise duration in chronic stable angina pectoris. Zatebradine investigators. Am J Cardiol 79:1401–1405
23. Hausberg M, Mark AL, Winniford MD, Brown RE, Somers VK (1997) Sympathetic and vascular effects of short-term passive smoke exposure in healthy nonsmokers. Circulation 96:282–287
24. Hunt BE, Taylor JA, Hamner JW, Gagnon M, Lipsitz LA (2001) Estrogen replacement therapy improves baroreflex regulation of vascular sympathetic outflow in postmenopausal women. Circulation 103:2909–2914
25. Izzat MB, Birdi I, Wilde P, Bryan AJ, Angelini GD (1996) Comparison of hemodynamic performances of St. Jude Medical and CarboMedics 21 mm aortic prostheses by means of dobutamine stress echocardiography. J Thorac Cardiovasc Surg 111:408–415
26. Jackson G, Benjamin N, Jackson N, Allen MJ (1999) Effects of sildenafil citrate on human hemodynamics. Am J Cardiol 83:13C–20C
27. Jacob G, Shannon JR, Costa F, Furlan R, Biaggioni I, Mosqueda-Garcia R, Robertson RM, Robertson D (1999) Abnormal norepinephrine clearance and adrenergic receptor sensitivity in idiopathic orthostatic intolerance. Circulation 99:1706–1712
28. Jamil G, Ahlberg AW, Elliott MD, Hendel RC, Holly T, McGill CC, Sarkis M, White MP, Mather JF, Waters DD, Heller GV (1999) Impact of limited treadmill exercise on adenosine Tc-99m sestamibi single-photon emission computed tomographic myocardial perfusion imaging in coronary artery disease. Am J Cardiol 84:400–403
29. Kouatli AA, Garcia JA, Zellers TM, Weinstein EM, Mahony L (1997) Enalapril does not enhance exercise capacity in patients after Fontan procedure. Circulation 96:1507–1512
30. Kubo T, Azevedo ER, Newton GE, Parker JD, Floras JS (2001) Lack of evidence for peripheral alpha(1)-adrenoceptor blockade during long-term treatment of heart failure with carvedilol. J Am Coll Cardiol 38:1463–1469
31. Kuhlkamp V, Schirdewan A, Stangl K, Homberg M, Ploch M, Beck OA (2000) Use of metoprolol CR/XL to maintain sinus rhythm after conversion from persistent atrial fibrillation: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 36:139–146
32. Lagi A, Cencetti S, Corsoni V, Georgiadis D, Bacalli S (2001) Cerebral vasoconstriction in vasovagal syncope: any link with symptoms? A transcranial Doppler study. Circulation 104:2694–2698
33. Lam FY, Wilson AT, Channer KS (1996) The effect of meals of differing composition on exercise tolerance in patients with angina pectoris. Eur Heart J 17:394–398
34. Lee M, Giardina EG, Homma S, DiTullio MR, Sciacca RR (1997) Lack of effect of estrogen on rest and treadmill exercise in postmenopausal women without known cardiac disease. Am J Cardiol 80:793–797
35. Lee CY, Pellikka PA, McCully RB, Mahoney DW, Seward JB (1999) Nonexercise stress transthoracic echocardiography: transesophageal atrial pacing versus dobutamine stress. J Am Coll Cardiol 33:506–511
36. Lewis WR, Carlson MD (1997) Systolic blood pressure at rest, not the degree of beta blockade, predicts the result of follow-up tilt-table testing for vasovagal syncope. Am J Cardiol 80:351–353
37. Maack C, Elter T, Nickenig G, LaRosee K, Crivaro M, Stablein A, Wuttke H, Bohm M (2001) Prospective crossover comparison of carvedilol and metoprolol in patients with chronic heart failure. J Am Coll Cardiol 38:939–946
38. Metra M, Giubbini R, Nodari S, Boldi E, Modena MG, Dei Cas L (2000) Differential effects of beta-blockers in patients with heart failure: a prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Circulation 102:546–551
39. Meyer K, Gornandt L, Schwaibold M, Westbrook S, Hajric R, Peters K, Beneke R, Schnellbacher K, Roskamm H (1997) Predictors of response to exercise training in severe chronic congestive heart failure. Am J Cardiol 80:56–60
40. Nagel E, Lehmkuhl HB, Bocksch W, Klein C, Vogel U, Frantz E, Ellmer A, Dreysse S, Fleck E (1999) Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 99:763–770
41. Narkiewicz K, van de Borne PJ, Pesek CA, Dyken ME, Montano N, Somers VK (1999) Selective potentiation of peripheral chemoreflex sensitivity in obstructive sleep apnea. Circulation 99:1183–1189
42. Noll G, Wenzel RR, de Marchi S, Shaw S, Luscher TF (1997) Differential effects of captopril and nitrates on muscle sympathetic nerve activity in volunteers. Circulation 95:2286–2292
43. Nul DR, Doval HC, Grancelli HO, Varini SD, Soifer S, Perrone SV, Prieto N, Scapin O (1997) Heart rate is a marker of amiodarone mortality reduction in severe heart failure. The GESICA-GEMA investigators. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina-Grupo de Estudios Multicentricos en Argentina. J Am Coll Cardiol 29:1199–1205
44. Oberman AS, Harada RK, Gagnon MM, Kiely DK, Lipsitz LA (1999) Effects of postprandial walking exercise on meal-related hypotension in frail elderly patients. Am J Cardiol 84:1130–1132
45. Parodi O, Neglia D, Palombo C, Sambuceti G, Giorgetti A, Marabotti C, Gallopin M, Simonetti I, L’Abbate A (1997) Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hypertension. Circulation 96:864–873
46. Phillips BG, Kato M, Pesek CA, Winnicki M, Narkiewicz K, Davison D, Somers VK (2000) Sympathetic activation by sildenafil. Circulation 102:3068–3073
47. Poldermans D, Fioretti PM, Boersma E, Bax JJ, Thomson IR, Roelandt JR, Simoons ML (1999) Long-term prognostic value of dobutamine-atropine stress echocardiography in 1737 patients with known or suspected coronary artery disease: a single-center experience. Circulation 99:757–762
48. Quyyumi AA (1998) Does acute improvement of endothelial dysfunction in coronary artery disease improve myocardial ischemia? A double-blind comparison of parenteral D- and L-arginine. J Am Coll Cardiol 32:904–911
49. Robbins M, Francis G, Pashkow FJ, Snader CE, Hoercher K, Young JB, Lauer MS (1999) Ventilatory and heart rate responses to exercise: better predictors of heart failure mortality than peak oxygen consumption. Circulation 100:2411–2417
50. Russell SD, Koshkarian GM, Medinger AE, Carson PE, Higginbotham MB (1999) Lack of effect of increased inspired oxygen concentrations on maximal exercise capacity or ventilation in stable heart failure. Am J Cardiol 84:1412–1416
51. Shoemaker JK, O’Leary DD, Hughson RL (2001) PET(CO(2)) inversely affects MSNA response to orthostatic stress. Am J Physiol Heart Circ Physiol 281:H1040–H1046
52. Spaanderman ME, Meertens M, van Bussel M, Ekhart TH, Peeters LL (2000) Cardiac output increases independently of basal metabolic rate in early human pregnancy. Am J Physiol Heart Circ Physiol 278:H1585–H1588
53. Stengele E, Ruf G, Jahnchen E, Trenk D, Loffler K, Schulz W, Roskamm H (1996) Short-term hemodynamic, anti-ischemic, and antianginal effects of pirsidomine: a new sydnonimine. Am J Cardiol 77:937–941
54. Tsoukas A, Ikonomidis I, Cokkinos P, Nihoyannopoulos P (1997) Significance of persistent left ventricular dysfunction during recovery after dobutamine stress echocardiography. J Am Coll Cardiol 30:621–626
55. Wray DW, Formes KJ, Weiss MS, AH OY, Raven PB, Zhang R, Shi X (2001) Vagal cardiac function and arterial blood pressure stability. Am J Physiol Heart Circ Physiol 281:H1870–H1880
56. Zhang R, Behbehani K, Crandall CG, Zuckerman JH, Levine BD (2001) Dynamic regulation of heart rate during acute hypotension: new insight into baroreflex function. Am J Physiol Heart Circ Physiol 280:H407–H419
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Vogel, C.U., Wolpert, C. & Wehling, M. How to measure heart rate?. Eur J Clin Pharmacol 60, 461–466 (2004). https://doi.org/10.1007/s00228-004-0795-3
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DOI: https://doi.org/10.1007/s00228-004-0795-3