Pharmacopsychiatry 2016; 49(01): 18-22
DOI: 10.1055/s-0035-1565204
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Elevated Rest Heart Rate in Psychiatric Patients and Different Effects of Psychotropic Medication

J. Sarlon
1   Department of Psychiatry, University Hospital Frankfurt am Main, Germany
,
O. Habich
2   Department of Internal and Geriatric Medicine, Diakonissen Hospital Frankfurt am Main, Germany
,
B. Schneider
3   Department of Addictive Disorders, Landschaftsverband Rheinland Clinic Cologne, Germany
› Author Affiliations
Further Information

Publication History

received 12 April 2015
revised 10 October 2015

accepted 27 October 2015

Publication Date:
02 December 2015 (online)

Abstract

Introduction: Elevated rest heart rate (RHR) is a known risk factor of cardiovascular diseases. The aim of this study was to analyse the effects of different psychiatric disorders and psychotropic medication on RHR.

Methods: In this retrospective study, medical records of 590 inpatients with a psychiatric disorder (309 men, 281 women, mean age 42.11; SD=13.8 years) were evaluated. RHR, the psychiatric diagnosis according to ICD-10, the psychotropic medication and the use of beta blockers were assessed.

Results: The average RHR of all patients was 85.62 beats per minute (bpm) (SD=10.60 bpm) which is, according to the literature and the consensus of experts, to be considered as a relevant elevation of RHR. There was a significant negative correlation between age and RHR. Patients treated with monotherapy or with SSRI showed in the multiple regression analysis significant lower RHR than other subjects, whereas both polytherapy with more antipsychotics and the diagnosis of schizophrenia could be identified as an independent risk factor of elevated RHR (p<0.05, 2-tailed). The presence of hypertonia, diabetes, hypercholesterolemia or obesity has no influence on RHR. 6% of the study population received beta blocker during the hospitalization.

Discussion: The elevated RHR in psychiatric patients is a common phenomenon and can be observed independently of the use of psychotropic medication but more in patients with schizophrenia. An interesting additional finding could be a possible protective effect of SSRI on RHR in psychiatric patients.

 
  • References

  • 1 Ji C, Zheng X, Chen S et al. Impact of resting heart rate on the progression to hypertension in prehypertension patients. Zhonghua Xin Xue Guan Bing Za Zhi 2014; 42: 860-865
  • 2 Palatini P. Role of elevated heart rate in the development of cardiovascular disease in hypertension. Hypertension 2011; 58: 745-750
  • 3 Palatini P. Heart rate as a cardiovascular risk factor: do women differ from men?. Ann Med 2001; 33: 213-221
  • 4 Pfister R, Michels G, Sharp SJ et al. Resting heart rate and incident heart failure in apparently healthy men and women in the EPIC-Norfolk study. Eur J Heart Fail 2012; 14: 1163-1170 Epub 2012 Jun 26
  • 5 Palatini P, Mos L, Santonastaso M et al. Resting heart rate as a predictor of body weight gain in the early stage of hypertension. Obesity 2011; 19: 618-623
  • 6 Shigetoh Y, Adachi H, Yamagishi S et al. Higher heart rate may predispose to obesity and diabetes mellitus: 20-year prospective study in a general population. Am J Hypertens 2009; 22: 151-155
  • 7 Custodis F, Schirmer SH, Baumhäkel M et al. Vascular pathophysiology in response to increased heart rate. J Am Coll Cardiol 2010; 56: 1973-1983
  • 8 Masuo K, Kawaguchi H, Mikami H et al. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertension 2003; 42: 474-480
  • 9 Palatini P, Longo D, Zaetta V et al. Evolution of blood pressure and cholesterol in stage 1 hypertension: role of autonomic nervous system activity. J Hypertens 2006; 24: 1375-1381
  • 10 Palatini P, Benetos A, Grassi G et al. Identification and management of the hypertensive patient with elevated heart rate: statement of a European Society of Hypertension Consensus Meeting. J Hypertens 2006; 24: 603-610
  • 11 Perret-Guillaume C, Joly L, Benetos A. Heart rate as a risk factor for cardiovascular disease. Prog Cardiovasc Dis 2009; 52: 6-10
  • 12 King DE, Everett CJ, Mainous 3rd AG et al. Long-term prognostic value of resting heart rate in subjects with prehypertension. Am J Hypertens 2006; 19: 796-800
  • 13 Okin PM, Kjeldsen SE, Julius S et al. All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy. Eur Heart J 2010; 31: 2271-2279
  • 14 Palatini P, Thijs L, Staessen JA et al. Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension. Arch Intern Med 2002; 162: 2313-2321
  • 15 Paul L, Hastie CE, Li WS et al. Resting heart rate pattern during follow-up and mortality in hypertensive patients. Hypertension 2010; 55: 567-574
  • 16 Lonn EM, Rambihar S, Gao P et al. Heart rate is associated with increased risk of major cardiovascular events, cardiovascular and all-cause death in patients with stable chronic cardiovascular disease: an analysis of ONTARGET/TRANSCEND. Circulation 2010; 122: A12667
  • 17 Nauman J, Janszky I, Vatten LJ et al. Temporal Changes in Resting Heart Rate and Deaths From Ischemic Heart Disease. JAMA 2011; 306: 2579-2587
  • 18 Bjerregaard P. Mean 24 hour heart rate, minimal heart rate and pauses in healthy subjects 40–79 years of age. Eur Heart J 1983; 4: 44-51
  • 19 Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health 2005; 26: 469-500
  • 20 Lin HP, Lin HY, Lin WL et al. Effects of stress, depression, and their interaction on heart rate, skin conductance, finger temperature, and respiratory rate: sympathetic-parasympathetic hypothesis of stress and depression. J Clin. Psychol 2000; 67: 1080-1091
  • 21 Bär KJ, Rachow T, Schulz S et al The phrenic component of acute schizophrenia – a name and its physiological reality. PloS One 2012; 7: e33459
  • 22 Kamphuis MH, Geerlings MI, Giampaoli S et al. The association of depression with cardiovascular mortality is partly explained by health status. The FINE Study. J Affect Disord 2009; 114: 184-192
  • 23 Lee K, Park J, Choi J et al. Heart rate variability and metabolic syndrome in hospitalized patients with schizophrenia. J Korean Acad Nurs 2011; 41: 788-794
  • 24 Leistedt SJ, Linkowski P, Lanquart JP et al. Decreased neuroautonomic complexity in men during an acute major depressive episode: analysis of heart rate dynamics. Transl Psychiatry 2011; 1: e27
  • 25 Lo Turco G, Grimaldi Di Terresena L. Spectral analysis of Heart Rate Variability in psychiatric patients: autonomic nervous system evaluation in psychotic, anxiety and depressive disorders. Riv Psichiatr 2012; 47: 139-148
  • 26 O'Keefe JH, Bhatti SK, Bajwa A et al. Alcohol and cardiovascular health: the dose makes the poison…or the remedy. Mayo Clin Proc 2014; 89: 382-393
  • 27 Potter WZ, Manji HK. Catecholamines in depression: an update. Clin Chem 1994; 40: 279-287
  • 28 Ressler KJ, Nemeroff CB. Role of serotonergic and noradrenergic systems in the pathophysiology of depression and anxiety disorders. Depress Anxiety 2000; 12 (Suppl. 01) 2-19
  • 29 Salaycik KJ, Kelly-Hayes M, Beiser A et al. Depressive symptoms and risk of stroke: the Framingham Study. Stroke 2007; 38: 16-21 Epub 2006 Nov 30
  • 30 Shi S, Liang J, Liu T et al. Depression increases sympathetic activity and exacerbates myocardial remodeling after myocardial infarction: evidence from an animal experiment. PloS One 2014; 9: e101734
  • 31 Yamanaka G, Otsuka K, Hotta N et al. Depressive mood is independently related to stroke and cardiovascular events in a community. Biomed Pharmacother 2005; 59 (Suppl. 01) S31-S319
  • 32 Kemp AH, Quintana DS, Quinn CR et al. Major depressive disorder with melancholia displays robust alterations in resting state heart rate and its variability: implications for future morbidity and mortality. Front Psychol 2014; 5: 1387 DOI: 10.3389/fpsyg.2014.01387. ECollection 2014
  • 33 Everson-Rose SA, House JS, Mero RP. Depressive symptoms and mortality risk in a national sample: confounding effects of health status. Psychosom Med 2004; 66: 823-830
  • 34 Fujibayashi M, Matsumoto T, Kishida I et al. Autonomic nervous system activity and psychiatric severity in schizophrenia. Psychiatry Clin Neurosci 2009; 63: 538-545
  • 35 Iwamoto Y, Kawanishi C, Kishida I et al. Dose-dependent effect of antipsychotic drugs on autonomic nervous system activity in schizophrenia. BMC Psychiatry 2012; 12: 199
  • 36 Witchel HJ, Hancox JC, Nutt DJ. Psychotropic drugs, cardiac arrhythmia, and sudden death. J Clin Psychopharmacol 2003; 23: 58-77
  • 37 Agelink MW, Majewski T, Wurthmann C et al. Effects of newer atypical antipsychotics on autonomic neurocardiac function: a comparison between amisulpride, olanzapine, sertindole, and clozapine. J Clin Psychopharmacol 2001; 21: 8-13
  • 38 Cohen H, Loewenthal U, Matar M et al. Heart rate variability in schizophrenic patients treated with antipsychotic agents. Harefuah 2001; 140: 1142-1147 1231
  • 39 Eschweiler GW, Bartels M, Längle G et al. Heart-rate variability (HRV) in the ECG trace of routine EEGs: fast monitoring for the anticholinergic effects of clozapine and olanzapine?. Pharmacopsychiatry 2002; 35: 96-100
  • 40 Suttajit S, Srisurapanont M, Xia J et al. Quetiapine versus typical antipsychotic medications for schizophrenia. Cochrane Database Syst Rev 2013; 5 CD007815 Doi: DOI: 10.1002/14651858.CD007815.pub2.
  • 41 Moser M, Lehofer M, Hoehn-Saric R et al. Increased heart rate in depressed subjects in spite of unchanged autonomic balance. J Affect Disord 1998; 48: 115-124
  • 42 Lehofer M, Moser M, Hoehn-Saric R et al. Influence of age on the parasympatholytic property of tricycklic antidepressants. Psychiatry Res 1999; 85: 199-207
  • 43 Scalco AZ, Rondon MU, Trombetta IC et al. Muscle sympathetic nervous activity in depressed patients before and after treatment with sertraline. J Hypertens 2009; 27: 2429-2436
  • 44 Davies SJ, Jackson PR, Ramsay LE et al. No evidence that panic attacks are associated with the white coat effect in hypertension. J Clin Hypertens (Greenwich) 2003; 5: 145-152
  • 45 Bangalore S, Fh Messerli, Kostis JB et al. Cardiovascular protection using beta-blockers: a critical review of the evidence. J Am Coll Cardiolog 2007; 50: 563-72 Epub 2007 Jul 30