Are you unnerved by those studies showing a link between resting heart rates of 95 and all-cause mortality? Isn’t an RHR of 75 better than 95?

Just how bad is a
resting heart rate of 95 anyways?

“The range for what we technically consider a normal heart rate is between 60 and 100 beats/minute,” begins Michael Hoosien, MD, MSc, a cardiac electrophysiologist with Piedmont Heart Hospital in Atlanta, GA.

“A resting heart rate of 95 beats/minute would not necessarily concern me,” continues Dr. Hoosien.

“However, if the heart rate were to jump into the 100s at rest or with very minimal activity, this could be suggestive of deconditioning.

“Athletic training increases the degree of input from the vagus nerve at rest, and highly trained athletes tend to have slower heart rates because they have higher vagal nerve output.

“It is normal for heart rates to vary within the normal range (60 to 100 beats/minute) depending on time of day, degree of activity, mood and ingestion of various compounds (such as caffeine or medications).”

But Those Studies…
What about those studies that seem to show that the high end of the “normal” HR range is a predictor of all-cause mortality or is associated with more death rates from cardiovascular causes?

Dr. Hoosien explains, “Regarding higher resting heart rates and mortality, there are a lot of confounding issues that influence these data.

“For example, in individuals with risk factors for coronary artery disease (smoking, diabetes, poor lipid profiles, hypertension, strong family history), beta blocker therapy clearly reduces event rates and improves survival.

“This effect is mediated in part by the beta blockers lowering the heart rate, but the mechanism of action of these drugs is actually more complex than that.

“So when I see data suggesting that higher resting heart rates increase mortality, the first question is: Could it be related to lack of beta blocker use in higher risk individuals?

“In other words, if you have several risk factors for CAD, you should probably be on a beta blocker, and this therapy would lower your heart rate.

“In this context lower heart rates would be associated with lower mortality — but it would be the pleiotropic [multiple] effects of the drug and not solely a lower heart rate driving this beneficial outcome.”

Fitness Enthusiasts with High RHR
vs. Sedentary People with Low RHR

What the devil is going on when a gym rat or exercise enthusiast has a resting heart rate of 95 or 85, and a sedentary person – truly inactive – someone who wouldn’t know the inside of a gym if it hit them on the head – has an RHR of 65?

“Regarding some athletes having higher RHR and sedentary individuals having lower RHR, what means the most to someone like me is heart rate variability,” says Dr. Hoosien.

“If I’m evaluating an endurance athlete with a relatively faster heart rate at rest, the expectation would be that that person’s HR ramps up with exertion.

“In sedentary people, on the other hand, heart rates tend to ‘jump’ during exertion.

“That sudden jump in the sinus node output is indicative of imbalance in the autonomic nervous system, and that would be more concerning than someone with a resting sinus rate of 90 who creeps into the 100s slowly with increasing exertion.”

Another way to look at this is that of bolting across a parking lot in the rain.

A sedentary person with a 65 RHR will be panting hard at the end with a heart rate of perhaps 120.

They’ll still be “out of breath” three minutes later, HR still elevated way above baseline.

A physically fit individual with an RHR of 95, after bolting across the parking lot, will barely detect an increase in respiration and will feel immediate recovery – if any is even necessary – with their HR topping out at maybe 110. It’ll very soon be back to 95.

Their heart rate variability is superior to the sedentary person’s. The bottom line isn’t always RHR, but what it takes to get you panting.

Some people are panting after simply rushing from one room in the house to the other.

And they may have a resting pulse in only the 60s. Gee, if it took only hurrying from the kitchen to the living room to get them winded, they’re in pretty bad shape.

A stressful life full of anxiety can sometimes keep RHR at the 95 level in a fit person, but if it’s consistently over 100, then it’s time to see a cardiologist.

dr. hoosien

Dr. Hoosien treats patients with heart arrhythmias and has a special interest in catheter ablation of atrial fibrillation, management of ventricular and supraventricular tachycardia, and cardiac resynchronization therapy.