A Journal Article Based Approach to Understanding the Clinical Aspects of Hypertension
Volume 1 Issue 9
May 2016  
Context and Study Objective
In a previous issue, we learned of the prognostic value of pulse pressure in predicting cardiovascular events. The Paris Prospective Study sought to explore the relationship between resting heart rate and all-cause mortality over more than 20 years of follow up.

Design, Setting, and Participants
Consecutive employees of the Paris civil service undergoing mandatory health examination between 1967-1972 were included if they were aged 42-53, free of cardiovascular disease and had systolic pressures <180 mm Hg. Use of anti-hypertensive therapy was not mentioned. After 5 minutes of rest, heart rate was measured for 1 minute; hazard ratios for mortality data were calculated based on extended surveillance. 
Results
-Characteristics: 5,100 individuals were studied with an average age of 48. Mean BP: 140/79 mm Hg. BMI: 26 kg/m2. 11% smoked, 1.3% had DM. Total cholesterol 222 mg/dL. The use of anti-hypertensive therapy was not recorded. 
-The cohort was followed for ~23 years with 4.5% lost to follow up.
-Figure (top): Even when controlling for age, BMI, diabetes, BP, and lipids, there was a linear and graded relationship between resting pulse and the rate of death. 
Clinical Perspective
-The linear relationship between resting heart rate and all-cause mortality is consistent with prior studies demonstrating associations between pulse rate and coronary artery disease as well as sudden cardiac death.
-Figure (bottom): An intriguing theory is that all mammals have a finite number of heart beats; therefore, those with faster rates have shorter life expectancies. N.B.: humans are considered "outliers" because of the (evolutionarily) recent introduction of antibiotics and other life extending therapies.
-Study Limitations: T he use of anti-hypertensives, particularly rate slowing agents such as  β blockers, were not controlled for; however, they were rarely prescribed at the time of study onset.
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