Lisinopril effects on heart rate
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Lisinopril and Heart Rate: Direct Effects
Research shows that lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, generally does not cause significant direct changes in resting heart rate in humans or animal models. In studies with normotensive men and patients with heart failure, both acute and chronic administration of lisinopril led to reduced blood pressure without significant changes in heart rate, indicating that lisinopril does not typically induce reflex tachycardia or bradycardia under these conditions 48. Similarly, in isolated guinea pig hearts, lisinopril did not affect heart rate or cardiac conduction at therapeutic concentrations .
Lisinopril and Heart Rate Variability (HRV)
Heart Rate Variability Improvement
Lisinopril has been shown to improve heart rate variability (HRV), which is a marker of autonomic nervous system balance and cardiovascular health. In hypertensive rats, chronic lisinopril administration significantly increased HRV indices, reflecting enhanced sympathetic and vagal tone, with only minimal changes in the overall balance between these systems 12. This improvement in HRV was observed during both active (night) and inactive (day) periods .
Effects in Human Studies
In patients with hypertension, lisinopril treatment was associated with a decrease in heart rate concentration in the 69-83 beats/min range and a reduction in HRV in this range, suggesting a normalization of heart rate patterns with effective blood pressure control . In patients with chronic heart failure, lisinopril and valsartan both improved cardiac vagal control of heart rate, as measured by HRV, with no significant difference between the two drugs .
Lisinopril and Sympathetic Heart Rate Response
Lisinopril may enhance the sympathetic heart rate response during exercise, especially in the early phase after acute myocardial infarction. In one study, patients treated with lisinopril showed a greater improvement in heart rate response to exercise compared to controls, particularly in the first month after the event . This effect was linked to a lower increase in plasma norepinephrine, indicating reduced sympathetic activation 3510.
Lisinopril in Special Populations
Heart Failure and Atrial Fibrillation
In patients with heart failure and chronic atrial fibrillation, lisinopril did not significantly affect heart rate during exercise or ambulatory monitoring, but it did tend to lower plasma norepinephrine levels, suggesting a reduction in adrenergic drive . Improvements in left ventricular function and exercise capacity were also observed, likely due to the overall cardiovascular benefits of ACE inhibition 56.
Reflex Control and Autonomic Function
Lisinopril may influence reflex control of heart rate by enhancing parasympathetic activity. It was found to impair certain vagally mediated reflexes, such as the cardiac acceleration when lying down and the bradycardia induced by facial immersion, without affecting baroreflexes or sympathetic function . This suggests that lisinopril can modulate autonomic tone, favoring parasympathetic activity.
Conclusion
Lisinopril does not significantly alter resting heart rate but can improve heart rate variability and autonomic balance, particularly in hypertensive and heart failure populations. It may enhance sympathetic heart rate response during exercise after myocardial infarction and reduce adrenergic activity, contributing to its cardiovascular protective effects. Overall, lisinopril’s impact on heart rate is subtle and primarily beneficial through improved autonomic regulation rather than direct chronotropic effects.
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