How to decrease resting heart rate, specifically to manage bradycardia (abnormally slow heart rate) or tachycardia (abnormally fast heart rate)?

From the Guidelines

To manage bradycardia or tachycardia, the most effective approach is to use beta-blockers or nondihydropyridine calcium channel antagonists to control resting heart rate, as recommended by the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1.

Key Considerations

• The goal is to improve morbidity, mortality, and quality of life by managing abnormal heart rates.
• Beta-blockers, such as metoprolol or atenolol, are commonly used to lower heart rate, but should only be used under medical supervision.
• Nondihydropyridine calcium channel antagonists are also effective in controlling resting heart rate, especially in patients with heart failure with preserved ejection fraction (HFpEF) 1.

Additional Management Strategies

• For symptomatic bradycardia, atropine 0.5 to 1 mg IV repeated every 3 to 5 minutes as needed up to 1.5 to 3 mg total is recommended as first-line treatment, with epinephrine or dopamine considered if atropine is not effective 1.
• Ivabradine, an inhibitor of the "I-funny" or "If" channel, can reduce the sinus node pacemaker activity, resulting in slowing of the heart rate, and has been approved for use in patients with systolic heart failure 1.
• Radiofrequency ablation to modify the sinus node can reduce the sinus rate, but is typically reserved for highly symptomatic patients who cannot be adequately treated by medication, due to the potential for significant harm 1.

Lifestyle Modifications

• Regular aerobic exercise, such as running, swimming, or cycling, can help strengthen the heart and improve cardiovascular efficiency, leading to a lower resting heart rate.
• Stress-reduction techniques, such as meditation, deep breathing, or yoga, can help reduce sympathetic nervous system activity and enhance parasympathetic tone, which can help lower heart rate.
• Adequate sleep, proper hydration, and a heart-healthy diet rich in omega-3 fatty acids can also support cardiovascular health and help manage abnormal heart rates.

From the FDA Drug Label

In standard animal or human pharmacological tests, beta-adrenoreceptor blocking activity of atenolol has been demonstrated by: (1) reduction in resting and exercise heart rate and cardiac output, A significant beta-blocking effect of atenolol, as measured by reduction of exercise tachycardia, is apparent within one hour following oral administration of a single dose. Bradycardia, including sinus pause, heart block, and cardiac arrest have occurred with the use of metoprolol.

Decreasing Resting Heart Rate:

• Beta-blockers such as atenolol and metoprolol can decrease resting heart rate by reducing the effects of catecholamines on the heart.
• Atenolol has been shown to reduce resting and exercise heart rate and cardiac output in standard animal or human pharmacological tests.
• Metoprolol can cause bradycardia, including sinus pause, heart block, and cardiac arrest, especially in patients with first-degree atrioventricular block, sinus node dysfunction, or conduction disorders.

Managing Bradycardia or Tachycardia:

• To manage bradycardia, the dose of beta-blockers such as metoprolol may need to be reduced or stopped.
• To manage tachycardia, beta-blockers such as atenolol and metoprolol can be used to reduce heart rate.
• However, caution is advised when using beta-blockers in patients with certain medical conditions, such as heart failure, coronary artery disease, or bronchospastic disease. 2 3

From the Research

Decreasing Resting Heart Rate

To manage bradycardia (abnormally slow heart rate) or tachycardia (abnormally fast heart rate), several strategies can be employed to decrease resting heart rate. The following methods have been supported by research:

• Regular exercise: Studies have shown that regular exercise, particularly endurance training and yoga, can significantly decrease resting heart rate in both healthy individuals and those with certain health conditions 4, 5, 6, 7.
• Aerobic exercise: Aerobic exercise, such as walking, jogging, or cycling, has been found to decrease resting heart rate and improve cardiovascular fitness 5, 6, 7.
• Frequency and duration of exercise: Exercise should be performed at a frequency of 3 to 5 days per week, with a duration of 20 to 60 minutes, and an intensity of 60% to 90% of maximum heart rate 6, 7.
• Type of exercise: Endurance training, yoga, and aerobic exercise have been found to be effective in decreasing resting heart rate, while strength training and other types of exercise may not have the same effect 4, 5, 6, 7.
• Age and training length: Older adults may require longer training periods, typically more than 30 weeks, to achieve significant reductions in resting heart rate 7.
• Medication: Beta-blockers, a type of medication commonly used to treat cardiovascular disorders, can also decrease resting heart rate, but may impair exercise performance, particularly with non-selective blockade 8.

Factors Influencing Resting Heart Rate Reduction

Several factors can influence the reduction of resting heart rate, including:

• Pre-interventional resting heart rate: Individuals with higher pre-interventional resting heart rates may experience greater reductions in resting heart rate with exercise 4.
• Age: Older adults may require longer training periods to achieve significant reductions in resting heart rate 7.
• Type of exercise: Different types of exercise, such as endurance training, yoga, and aerobic exercise, may have varying effects on resting heart rate reduction 4, 5, 6, 7.
• Medication: The use of beta-blockers and other medications can influence resting heart rate and exercise performance 8.