Does lisinopril lower heart rate
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The Impact of Lisinopril on Heart Rate: A Comprehensive Review
Introduction to Lisinopril and Heart Rate
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used for managing hypertension and heart failure. While its efficacy in lowering blood pressure is well-documented, its effects on heart rate are less clear. This article synthesizes findings from multiple studies to determine whether lisinopril lowers heart rate.
Lisinopril and Heart Rate Variability
Heart Rate Variability in Hypertensive Rats
A study on spontaneously hypertensive rats treated with lisinopril for 10 weeks showed significant improvements in heart rate variability (HRV) during both active and inactive periods. However, the study did not report a direct reduction in heart rate, focusing instead on the variability and distribution patterns of R-R intervals.
Clinical Studies on Lisinopril and Heart Rate
Antihypertensive Effectiveness in Humans
A large multicenter study involving patients with mild to moderate hypertension found that lisinopril, both as monotherapy and in combination with hydrochlorothiazide, effectively reduced blood pressure without significantly affecting heart rate. This suggests that while lisinopril is effective in lowering blood pressure, it does not necessarily lower heart rate.
Sympathetic Heart Rate Response Post-Myocardial Infarction
In patients with acute myocardial infarction, lisinopril improved the sympathetic heart rate response during exercise in the early phase of recovery. However, the study did not find a significant change in resting heart rate. This indicates that lisinopril may enhance heart rate response under stress conditions but does not lower the baseline heart rate.
Hemodynamic and Hormonal Effects in Heart Failure
A study assessing the acute hemodynamic and hormonal effects of lisinopril in patients with heart failure reported no significant changes in heart rate despite reductions in mean arterial pressure and systemic vascular resistance. This further supports the notion that lisinopril does not lower heart rate in heart failure patients.
Comparative Studies with Other Medications
Combination with Beta-Blockers
When combined with beta-blockers like carvedilol, lisinopril was found to lower the mean and variability of heart rate more effectively than when combined with valsartan, an angiotensin receptor blocker. However, this effect was attributed to the beta-blocker rather than lisinopril itself.
Autonomic Nervous System Activity
In a study comparing lisinopril with valsartan, both medications showed similar effects on heart rate variability and baroreflex sensitivity. However, valsartan was more effective in reducing plasma norepinephrine levels, indicating a greater impact on sympathetic activity.
Conclusion
The evidence suggests that while lisinopril is effective in lowering blood pressure and improving heart rate variability, it does not significantly lower heart rate. Its effects on heart rate are more pronounced under stress conditions or when combined with other medications like beta-blockers. Therefore, lisinopril's primary benefit lies in its ability to manage blood pressure and improve heart rate variability rather than directly lowering heart rate.
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