Is a Resting Heart Rate Below 45 BPM a Cause for Concern?

Is there a problem if the resting heart rate drops below 45? Thank you!

Due to hypertension issues, I have been taking Sevikar 40/5/12.5 mg for the past few years, and my blood pressure has been well controlled.
During my last follow-up appointment last month, my fasting blood sugar (AC) was slightly elevated at 105, and there were minor abnormalities in my exercise electrocardiogram.
The doctor advised me to switch to four medications: Norvasc 5 mg, Crestor 10 mg, Nebilet 5 mg, and Bokey 5 mg.
Since starting Nebilet, my resting heart rate has dropped to 45 (previously around 60), and during sleep, my heart rate has fallen to 40-50 (previously around 50-60).
I would like to know if having such a low heart rate on a regular basis could pose any problems.

Mr. Chen, 60~69 year old female. Ask Date: 2024/04/24

Dr. Li Han reply Cardiology

Hello, based on your description, after changing the medication, Nebilet has reduced your resting heart rate to 50 beats per minute.
If you are not experiencing any discomfort and your heart rate can appropriately increase during activity, it may indicate that your heart function and variability are adequate.
Currently, there should be no concerns.
However, unless there is a compelling reason, using Nebilet to excessively lower the heart rate may not provide evidence-based benefits and could pose risks.
It would be advisable to discuss with your physician at your next appointment whether to consider changing the medication.
The Ministry of Health and Welfare Changhua Hospital cares about you.

Reply Date: 2024/04/24

More Info

A resting heart rate below 45 beats per minute (BPM) can indeed be a cause for concern, especially if it is a new development or accompanied by symptoms. In your case, you mentioned that your resting heart rate has dropped to around 45 BPM after starting Nebilet (Nebivolol), a medication commonly used to treat high blood pressure and heart conditions. While it is not uncommon for athletes or individuals who are physically fit to have lower resting heart rates, a significant drop in heart rate, particularly if it falls below 50 BPM, warrants careful evaluation.

Firstly, it is essential to understand that a normal resting heart rate for adults typically ranges from 60 to 100 BPM. Rates below 60 BPM are classified as bradycardia. While some individuals, especially those who are physically active, may naturally have lower heart rates, a sudden decrease in heart rate, especially to levels below 45 BPM, can indicate an underlying issue. This is particularly true if you experience symptoms such as dizziness, fatigue, shortness of breath, or fainting.

In your situation, the drop in heart rate could be attributed to the initiation of Nebilet, which is a beta-blocker. Beta-blockers work by slowing down the heart rate and reducing the force of contraction of the heart muscle, which can be beneficial for managing high blood pressure and certain heart conditions. However, if the heart rate becomes too low, it may lead to inadequate blood flow to the organs, resulting in symptoms of bradycardia.

It is crucial to monitor how you feel with this new heart rate. If you are asymptomatic—meaning you do not experience any adverse symptoms—this may be less concerning. However, if you notice symptoms such as excessive fatigue, dizziness, or any other unusual feelings, it is essential to contact your healthcare provider promptly. They may recommend adjusting your medication or conducting further tests, such as an electrocardiogram (ECG), to assess your heart's electrical activity and ensure there are no other underlying issues.

Additionally, considering your history of high blood pressure and recent changes in medication, it would be prudent to have a follow-up appointment with your physician. They can evaluate whether the benefits of continuing Nebilet outweigh the risks associated with a low heart rate. It may also be beneficial to discuss alternative medications or dosages that could help manage your blood pressure without causing such a significant drop in heart rate.

In summary, while a resting heart rate below 45 BPM can be concerning, the context of your overall health, symptoms, and the specific medications you are taking plays a crucial role in determining the significance of this finding. Regular monitoring and open communication with your healthcare provider are essential to ensure your heart health is managed effectively and safely.

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