What medications lower heart rate without affecting blood pressure, specifically treating tachycardia (abnormally fast heart rate)?

From the Guidelines

Ivabradine is the most effective medication for lowering heart rate without affecting blood pressure, as evidenced by the SHIFT trial 1. When considering medications that can lower heart rate without significantly impacting blood pressure, several options are available.

• Ivabradine (Corlanor, starting at 5mg twice daily) is a specific inhibitor of the If current involved in sinoatrial nodal activity and reduces the heart rate of patients in normal sinus rhythm without lowering blood pressure, as shown in the SHIFT trial 1.
• The benefits of ivabradine are particularly notable for patients with contraindications to beta-blockers, those on beta-blocker doses less than 50% of guideline-directed medical therapy (GDMT) targets, and patients with a resting heart rate greater than 77 beats/min at study entry 1. Key considerations for the use of ivabradine include:
• It is indicated only for patients mainly in sinus rhythm, not in those with persistent or chronic atrial fibrillation, those experiencing 100% atrial pacing, or unstable patients 1.
• A history of paroxysmal atrial fibrillation is not a contraindication to ivabradine, as nearly 10% of patients in the SHIFT study had a history of paroxysmal atrial fibrillation 1.
• Patients treated with ivabradine may experience greater rates of bradycardia and transient blurring of vision, emphasizing the need for careful medical supervision and monitoring 1.

From the FDA Drug Label

Bradycardia 10% 2.2% Hypertension, blood pressure increased 8.9% 7.8% Ivabradine can lower heart rate without significantly affecting blood pressure, as the incidence of hypertension or increased blood pressure is similar to that of the placebo group 2. Key points:

• Ivabradine can cause bradycardia, but its effect on blood pressure is minimal.
• The risk of bradycardia increases with concomitant administration of drugs that slow heart rate, such as beta-blockers 2.
• Ivabradine is not recommended in patients with demand pacemakers set to rates ≥ 60 beats per minute.

From the Research

Medications that Lower Heart Rate without Affecting Blood Pressure

• Ivabradine is a medication that has been shown to lower heart rate without affecting blood pressure 3, 4, 5, 6, 7
• It works by specifically blocking the I(f) current in the sinoatrial node, which controls the heart's rhythm 3, 4, 5
• Ivabradine has been found to be effective in reducing heart rate and improving exercise capacity in patients with stable angina 3, 4
• It has also been shown to be beneficial in patients with heart failure, reducing hospitalizations and improving symptoms 5, 7
• In patients with inappropriate sinus tachycardia, ivabradine has been found to be more effective than metoprolol in reducing heart rate and relieving symptoms 6

Key Benefits of Ivabradine

• Lowers heart rate without affecting blood pressure or myocardial contractility 3, 4, 5, 7
• Improves exercise capacity and reduces symptoms in patients with stable angina 3, 4
• Reduces hospitalizations and improves symptoms in patients with heart failure 5, 7
• Effective in treating inappropriate sinus tachycardia, especially in patients who cannot tolerate beta-blockers or calcium channel blockers 6, 7

Potential Uses of Ivabradine

• Stable angina 3, 4
• Heart failure with reduced ejection fraction 5, 7
• Inappropriate sinus tachycardia 6, 7
• Other cardiovascular conditions, such as cardiogenic shock and multiple organ dysfunction syndrome 5