What does your resting heart rate say about your risk of premature death?
A higher resting heart rate is robustly associated with a greater risk of premature death, even after adjustment for other risk factors. If your resting heart rate is structurally above 80, it is worth discussing this with your doctor, especially if you also have high blood pressure.
For every 10 extra beats per minute, the risk of dying from any cause rises by around 9%. Two large analyses, each pooling dozens of studies, arrived at this figure independently. Above 80 beats per minute at rest, the mortality risk was as much as 45% higher than in the lowest heart rate category, even after adjusting for blood pressure, cholesterol and other well-known risk factors.
This association is not limited to cardiovascular disease. A higher resting heart rate is also linked to a greater chance of dying from heart failure, stroke and cancer. The additional risk of cancer death at a resting heart rate of 80 or more amounts to 35% compared with people below 60 beats per minute. Good physical fitness can partially, but not fully, offset that risk.
The combination of a high resting heart rate and high blood pressure is particularly unfavourable. Research involving more than 67,000 people aged sixty and over showed that these two factors amplify each other: their combined effect on mortality was greater than either factor alone. If you have both, paying attention to blood pressure and heart rate is therefore doubly worthwhile.
Whether a high heart rate is itself harmful or merely a sign of an underlying problem is an important question. There are indications that the heart rate itself plays a role: heart-rate-lowering medications (independent of their other effects) reduce hospital admissions and mortality in heart failure. Full causal certainty does not yet exist, but the association is biologically plausible.
One exception deserves mention: in people around the age of 95, a higher resting heart rate did not predict a shorter life expectancy. The risk signal that is so consistent in younger and middle-aged groups appears to fade at very advanced ages. This finding comes from a smaller study and requires confirmation, but it is a striking observation.
This answer is based on two large analyses each pooling dozens of studies, supplemented by a study of more than 67,000 older adults, a study of 854 people around the age of 95, a study on fitness and cancer mortality, and two review articles on heart-rate-lowering medications. The association between resting heart rate and mortality is therefore broadly studied and consistent. Caveats: the researchers themselves report considerable variation between the pooled studies and indications of publication bias. The causality question (does a high heart rate cause harm, or is it a symptom?) has not yet been fully answered; the medication data represent the strongest indirect evidence for cause and effect.