Number 41 n August 24, 2011

Resting Pulse Rate Reference Data for Children, 

Adolescents, and Adults: United States, 1999–2008 by Yechiam Ostchega, Ph.D., R.N.; Kathryn S. Porter, M.D., M.S.; Jeffery Hughes, M.P.H.; Charles F. Dillon, M.D.,

Ph.D.; and Tatiana Nwankwo, M.S., Division of Health and Nutrition Examination Surveys

Abstract

Objective—This report presents national reference data on resting pulse rate (RPR),

for all ages of the U.S. population, from 1999–2008.

Methods—During 1999–2008, 49,114 persons were examined. From this, a

normative sample comprising 35,302 persons was identified as those who did not have

a current medical condition or use a medication that would affect the RPR. RPR was

obtained after the participant had been seated and had rested quietly for approximately

4 minutes.

Results—RPR is inversely associated with age. There is a mean RPR of 129 beats

per minute (standard error, or SE, 0.9) at less than age 1 year, which decreases to a

mean RPR of 96 beats/min (SE 0.5) by age 5, and further decreases to 78 beats/min

(SE 0.3) in early adolescence. The mean RPR in adulthood plateaus at 72 beats/min (SE

0.2) (p < 0.05 for trend). In addition, there is a significant gender difference, with the

male pulse rate plateauing in early adulthood, while the female resting pulse plateaus

later when middle-aged. There are two exceptions, that is, infants under age 1 year and

adults aged 80 and over, when the mean RPR is statistically and significantly higher in

females than in males (females under age 20 have an RPR of 90 beats/min, SE 0.3, and

males under age 20 have an RPR of 86 beats/min, SE 0.3, p < 0.05; females aged 20

and over have an RPR of 74 beats/min, SE 0.2, and males aged 20 and over have an

RPR of 71 beats/min, SE 0.3, p < 0.05). After controlling for age effects, non-Hispanic

black males have a significantly (p < 0.001) lower mean RPR (74 beats/min) than

non-Hispanic white males (77 beats/min) and Mexican-American males (76 beats/min).

Among females, non-Hispanic black females (79 beats/min) and Mexican-American

females (79 beats/min) had statistically and significantly (p < 0.01) lower mean RPRs

compared with non-Hispanic white females (80 beats/min). Among males, the

prevalence of clinically defined tachycardia (abnormally fast heart rate, RPR 100

beats/min) is 1.3% (95% CI = 1.1–1.7), and the prevalence of clinically defined

bradycardia (abnormally slow heart rate, RPR < 60 beats/min) is 15.2% (95% CI =

14.1–16.4). For adult females, these prevalences are 1.9% (95% CI = 1.6–2.3) for

clinical tachycardia and 6.9% (95% CI = 6.2–7.8) for clinical bradycardia. Controlling

for age, males have higher odds (2.43, 95% CI = 2.09–2.83) of having bradycardia, and

notably lower odds (0.71, 95% CI = 0.52–0.97) of having tachycardia than women.

Conclusions—The data provides current, updated population-based percentiles

of RPR, which is one of the key vital signs routinely measured in clinical practice.

Keywords: NHANES pulse reference • U.S. population

Introduction

Resting pulse rate (RPR) is one of

the key vital signs routinely measured in

clinical practice. For routine clinical

practice, it is important to have

reference ranges for healthy people and

reference ranges that are specific for the

U.S population. Such U.S. populationbased reference ranges for RPR were

first reported based on the first U.S.

National Health and Nutrition

Examination Survey (NHANES I) data,

collected from 1971–1975 (1,2).

Unfortunately, however, U.S. reference

ranges for RPR have not been updated

since that time.

NHANES I data showed significant

age and gender variation in RPR and

provided some of the initial

epidemiologic evidence that RPR may

be an independent risk factor for

cardiovascular disease. Specifically, over

a follow-up period of 6–13 years, data

from the NHANES I Epidemiologic

Follow-up Study showed a 40%

elevated relative risk for a coronary

heart disease (CHD) incidence in older

white males with a baseline pulse

greater than 84 beats/min. This was

compared with older white males with a

baseline pulse less than 74 beats/min,

controlling for multiple risk factors

(3,4). In addition, this study showed that

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2	 National Health Statistics Reports n Number 41 n August 24, 2011

in specific demographic subgroups,

CHD incidences increased among those

with an elevated pulse rate. This was

also true for white females, black males,

and black females. Females aged 50–64

years with an RPR greater than 76 beats

per minute at baseline were 47% more

likely to subsequently suffer from a

coronary event when compared with

women with an RPR of less than or

equal to 62 beats/min (5). Later studies

indicate that a relatively high RPR has

direct detrimental effects on the

progression of coronary atherosclerosis,

on the occurrence of myocardial

ischemia and ventricular arrhythmias,

and on left ventricular cardiac function

(6). A number of recent studies suggest

that RPR is an independent predictor of

both cardiovascular and all-cause

mortality among males and females

(7,8). The purpose of this report is to

provide updated national RPR reference

range data for the U.S. population based

on NHANES 1999–2008 survey data.

Methods

NHANES is conducted to assess the

health and nutritional status of the

civilian, noninstitutionalized U.S.

population. Prior to 1999, NHANES

surveys were conducted periodically.

The survey became continuous in 1999.

Nationally representative samples are

selected annually using a complex,

multistage sampling design that employs

probability, stratified, and cluster

sampling to produce U.S. national

prevalence estimates. Publicly available

data files are released biannually. For

NHANES 1999–2008, non-Hispanic

black persons, Mexican-American

persons, adolescents aged 12–19, adults

aged 60 and over, pregnant women

(1999–2006 only), and people of low

income were oversampled to obtain

more reliable statistical estimates for

those specific demographic subgroups.

In-person household interviews and

health examinations are used to collect

NHANES data. All NHANES health

examinations are conducted in a mobile

examination center (MEC), which

provides a standardized environment for

data collection. NHANES is conducted

with Institutional Review Board

approval and documented consent from

all participants (9).

Sample size and exclusion

criteria

From 1999 through 2008, 63,882

people were included in the eligible

sample, 51,623 people (about 80%)

were interviewed in the household, and

49,114 people were examined at the

MEC. Of those examined, 1,324

participants had missing resting pulse

data, and 180 participants had ‘‘recorded

age at the time of interview’’ but not at

‘‘physical exam time.’’ Therefore,

47,610 participants were available for

data analysis (75% of the total eligible

sample). The purpose of the RPR study

was to define the normative U.S.

reference range for resting pulse,

therefore, exclusion criteria were used to

create an analytic study sample that was

free of physiological, pathological, and

pharmacologic factors that could have

an effect on the resting pulse.

Specifically excluded from our

analytic sample were the following: 11

participants with pulse rates greater than

or equal to 200 beats/min; 740

participants with white blood cell counts

of greater than or equal to 12.9 x 109

/L

or who had a high-sensitivity C-reactive

protein of 10 mg/dl and greater (that is,

those likely to have a current infectious

illness); 9,083 participants currently

taking prescription medications that

could affect the heart rate

(decongestants, adrenergic agonists for

glaucoma, amphetamine,

dextroamphetamine, digitalis, βblockers, calcium channel blockers, and

β-agonist bronchodilators); 1,331

pregnant women; 523 participants with

irregular pulses; and 462 participants

with abnormal thyroid function (TSH

less than 0.34 IU/L or greater than 5.6

IU/L). The total sample available for the

normative analysis of RPR was 14,200

adults (aged 20 and over) and 21,102

children and adolescents (under age 20),

which was 72% of the total participants

examined in the MEC.

Heart rate measurements

and criteria

RPR was obtained by the examining

physician in the MEC. The participant’s

pulse was taken by physical examination

in the seated position after he or she had

been seated and resting quietly for

approximately 4 minutes. For children

aged 4 and under, the physician counted

the heart rate for 30 seconds by

auscultation of the heart at

approximately the left fourth intercostal

space, midclavicular line, using the bell

device of the pediatric stethoscope. For

participants over age 4, a radial pulse

rate was obtained manually by counting

for 30 seconds. All obtained RPRs were

multiplied by two to provide a 60­

second RPR in beats per minute (10).

Resting electrocardiogram was not

obtained in NHANES 1999–2008.

To ensure accurate results, there

was thorough physician training on the

collection of pulse-rate data and

extensive quality control monitoring of

the pulse-rate data collection. A

methodological limitation of the

cross-sectional measurement of RPR

was that the measurement was obtained

only on a one-time basis for each

participant. For each RPR, there was

both sampling measurement error and

some degree of biological variation in

measurement. These could not be

directly assessed given the available

data; however, during NHANES survey

years 2001–2002, second-day repeat

examinations were performed for a

selected convenience sample of

NHANES participants. Analysis of this

data for RPR showed an intraclass

correlation of 0.69 between the values

for RPR obtained on the two different

exam days (data not shown).

In addition to estimating means and

percentiles for RPR in the major U.S.

demographic subgroups, estimates were

produced for the prevalence of clinically

abnormal rapid heart rate (tachycardia)

and slow heart rate (bradycardia). Two

definitions were used to explain the

prevalence of clinical tachycardia and

bradycardia:

1.The traditional ‘‘clinical consensus’’

definition that is employed as a
 	 

 

 

 

	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

National Health Statistics Reports n Number 41 n August 24, 2011	 Page 3

standard in clinical practice

(tachycardia = RPR > 100 beats/min;

bradycardia = RPR < 60 beats/min).

2.	 A revised clinical guideline based on

an analysis of current cardiology

practice and epidemiologic survey

data (tachycardia = RPR > 90

beats/min; bradycardia = RPR < 50

beats/min) (11–18).

Statistical analyses

The analyses of RPR provide

population means, standard errors of the

means, and selected percentiles (1%,

2.5%, 5%, 10%, 25%, 50%, 75%, 90%,

95%, 97.5%, and 99%). All estimates

were weighted using the NHANES

MEC examination sample weights to

produce nationally representative

estimates. The NHANES examination

sample weights incorporate the

differential probabilities of participant

selection and include adjustments for the

oversampling of selected populations,

noncoverage, and nonresponse.

Statistical analyses used SAS (Release

9.2; SAS Institute Inc, Cary, N.C.) and

SUDAAN (Release 10.0; Research

Triangle Institute, Research Triangle

Park, N.C.), with standard errors

estimated using the SUDAAN Taylor

series linearization. The LOESS

procedure (Proc SGPLOT) in SAS was

used to create the smoothed graphs. This

procedure uses locally weighted

polynomial regression to fit a smoothed

line. The reliability of the estimates was

determined using the relative standard

error (RSE), a calculated figure defined

as the ratio of the standard error to the

mean. A recommended RSE greater than

30% was used to identify unreliable

estimates (9). Percentile values that did

not meet the standard of reliability or

precision were replaced with asterisks

(*) in all tables. The differences

between gender means were tested using

t-tests, and a regression analysis was

used to test for linear trend in age.

Regression analysis also was performed

using the Satterthwaite-adjusted F-test to

assess the independent contribution of

race and ethnicity to RPR controlling

for the covariates of sex, age, and age

squared. An alpha level of less than or

equal to 0.05 was considered statistically

significant. Prevalence estimates for race

and ethnicity and gender subgroups

were age adjusted (9). For reporting the

results of the normative analysis, age

was categorized according to the

‘‘NHANES 1999–2000 Analytic

Guidelines,’’ which are based on the

survey sample domains: less than 1, 1,

2–3, 4–5, 6–8, 9–11, 12–15, 16–19,

20–39, 40–59, 60–79, and greater than

80 (9). Race and ethnicity, based on

self-reported information, was classified

as non-Hispanic white, non-Hispanic

black, and Mexican American.

Participants not fitting the above

self-classifications were classified as

‘‘other.’’ Estimates are not shown

separately for persons in the residual

‘‘other’’ racial-ethnic group, although

these persons are included in the totals

and strata for the analyses by age

groups and sex (10).

Results

An overall analysis of the results

for the U.S. population (1999–2008)

confirms the findings of previous

NHANES studies, concluding that there

is significant variation in RPR by age

and sex (Table 1). Table 1 illustrates the

inverse association of RPR with age

with a rapid mean pulse rate of 129

beats/min, characteristic of infancy

decreasing to a mean pulse rate of 96

beats/min by age 5 years. Thereafter,

there is a slower decrease in RPR

during childhood and early adolescence

to the 83–78 beats/min range. Mean

RPR rate then again decreases slightly

and plateaus in adulthood at a mean of

72 beats/min. These decreases of RPR

are statistically significant (p is less than

0.05 for trend). Similarly, a statistical

analysis of RPR was performed by

gender (data not shown), confirming that

there are significant gender differentials

in RPR as well (p is less than 0.05).

Because of the known differences in

RPR within these major demographic

subgroups, the normative U.S.

population’s RPR statistical estimates

for the study are presented by age and

gender subgroups.

RPR in children and

adolescents

The overall mean RPR for male

children and adolescents is 86 beats/min.

The mean RPR ranges from 128

beats/min in male infants under age 1 to

72 beats/min in male adolescents aged

16–19 (Table 2). Figure 1 presents the

smoothed 5th and 95th percentile,

median (50%), and interquartile (25%

and 75%) ranges for males, and shows

the decrease in mean RPR that occurs

during the transition from infancy to

early adulthood (Figure 1; note that

persons with a current medical condition

or medication use that would affect the

RPR are excluded). The graph

demonstrates the decline in RPR that

typically occurs between infancy and

early childhood, as well as the more

gradual decline to lower RPRs (which

are more typical for adults) around ages

15–20.

The general trends for female

children and adolescents are similar to

those for male children and adolescents

(Table 3). The overall mean RPR for

female children and adolescents is 90

beats/min. The mean RPR ranges from

130 beats/min for female infants under

age 1 year to 79 beats/min in female

adolescents aged 16–19 (Table 3).

Figure 2 presents the smoothed 5th and

95th percentile, median (50%), and

interquartile (25% and 75%) ranges for

females, again showing the decrease in

mean RPR from infancy to early

childhood, as well as the more gradual

decline to lower RPRs, where RPR

values are more similar to those

prevalent among adults (Figure 2). This

figure excludes persons with a current

medical condition or medication use that

would affect the RPR. Figure 2 indicates

that a change to the lower mean RPR

for adolescent females may begin to

occur around ages 15–20.

RPR in adults

The overall mean RPR for adult

males is 71 beats/min. The range of

mean RPRs in males is similar across
Page 4 National Health Statistics Reports n Number 41 n August 24, 2011

Figure 1. Resting pulse rates for U.S. males, by age: National Health and Nutrition Examination Survey, 1999–2008

the four adult age groups: 71 beats/min

in those aged 20–39; 71 beats/min in

those aged 40–59; 70 beats/min in those

aged 60–79; and 71 beats/min among

those aged 80 and over (Table 2).

Similarly, Figure 1 presents the

smoothed 5th and 95th percentile,

median (50%), and interquartile (25%

and 75%) ranges for males, showing

very little change in median RPR among

males from early adulthood into old age.

The overall mean RPR for women

is 74 beats/min (Table 3). The mean

RPR is 76 beats/min among females

aged 20–39 and 73 beats/min among

females aged 40 and over. Figure 2

presents the smoothed median (50%)

and interquartile (25% and 75%) RPR

ranges for females. The overall trends in

RPR by increasing age from childhood

to adulthood are similar to those found

in males.

Statistical analysis of age

and RPR

Further statistical analysis was

performed to assess the effects of

increasing age on RPR. An analysis of

mean RPR by age categories confirms

that RPR decreased significantly with

increasing age (p is less than 0.0001 for

trend) for children and adolescents of

both sexes. In a similar analysis for the

adult age ranges, for males, there was

no statistically significant trend in RPR

across the four adult age groups (p is

greater than 0.05 for trend); however,

this was not the case for adult females,

where a significant trend in decreasing

RPR was seen across the four adult age

groups (p is less than 0.05 for trend).

Figure 3 is a box-and-whisker plot

where the horizontal line represents the

median, the diamond represents the

mean, the box represents the

interquartile range (25th and 75th

percentile) distribution, the top and

bottom horizontal lines (the ‘‘whiskers’’)

represent the largest and smallest values

not considered outliers, while the circles

represent outlier observations. This

figure excludes persons with a current

medical condition or medication use that
National Health Statistics Reports n Number 41 n August 24, 2011 Page 5

Figure 2. Resting pulse rates for females, by age: National Health and Nutrition Examination Survey, 1999–2008

would affect the RPR. Figure 3 displays

RPR values by sex and age group.

These graphs suggest that for males, the

age-associated decrease in RPR plateaus

to a relatively steady-state adult level

around age 16, while for females the

age-associated decrease in RPR appears

be more gradual, plateauing much later

in adulthood around age 40. To further

assess these findings, a gender-specific

regression analysis was performed in

which ordinal age groups were

contrasted against each other

sequentially, controlling for the covariate

race and ethnicity. The analysis shows

that for males up to age 19, all mean

RPR comparisons between successive

age groups has statistically significant

decreases in mean RPR (Satterthwaiteadjusted F = p < 0.01, data not shown).

However, this pattern changes when the

mean RPR for the 16–19 age group is

contrasted with the 20–39 age group.

With this contrast, the mean RPR

difference between the age groups is no

longer statistically significant

(Satterthwaite-adjusted F, p = 0.18),

providing statistical evidence that this

age range in males represents the

transition to adult RPR values. A similar

analysis was performed for females. For

females, the statistically defined

transition point from progressive

significant decreases in the mean RPR

by age group to a plateau where no

statistically significant differences occur

is observed between the 40–59 and the

60–79 age groups (data not shown).

Figure 4 shows histograms overlaid

by smoothed normal curves representing

the frequency distribution of RPR by

age groups and sex. This figure excludes

persons with a current medical condition

or medication use that would affect the

RPR. Overall, the curves appear to

approximate the normal distribution with

a few outliers on both the left and the

right of the curves. The curves also

appear to be progressing from a

platykurtic to a leptokurtic shape, which

suggests the narrowing of the

distribution with increased age.

Statistical analysis of sex

and RPR

When the mean RPRs for males and

females are compared within each of the
Page 6 National Health Statistics Reports n Number 41 n August 24, 2011

Figure 3. Box plot of resting pulse rate for U.S. males and females, by age group: National Health and Nutrition Examination Survey,

1999–2008
National Health Statistics Reports n Number 41 n August 24, 2011 Page 7 

Figure 4A. Histograms and smoothed distributions of resting pulse rate for U.S. males and females, by age group: National Health and

Nutrition Examination Survey, 1999–2008
Page 8 National Health Statistics Reports n Number 41 n August 24, 2011

Figure 4B. Histograms and smoothed distributions of resting pulse rate for U.S. males and females, by age group: National Health and

Nutrition Examination Survey, 1999–2008
National Health Statistics Reports n Number 41 n August 24, 2011 Page 9 

Figure 4C. Histograms and smoothed distributions of resting pulse rate for U.S. males and females, by age group: National Health and

Nutrition Examination Survey, 1999–2008
Page 10 National Health Statistics Reports n Number 41 n August 24, 2011

eight childhood and adolescent age

groups (Tables 2 and 3), mean RPRs are

found to be significantly different by

sex, with female children and

adolescents having a higher RPR than

male children and adolescents. The

exception is infants under age 1 year

(means infant males = 128 beats/min,

infant females = 130 beats/min;

p > 0.05). When comparing male RPRs

with female RPRs within each of the

four adult age categories, female mean

RPRs were significantly higher than

male mean RPRs (p is less than 0.05),

except for the oldest age group (80 and

over), in which the difference between

sex is no longer statistically significant

(p > 0.05).

RPR by race and ethnicity

RPR varied across adult racial and

ethnic categories, but more so in

females than in males. An analysis was

performed using age-adjusted prevalence

estimates for the main race and ethnicity

subgroups stratified by sex. After

controlling for age, non-Hispanic black

males have a significantly (p > 0.001)

lower mean RPR (74 beats/min) than

non-Hispanic white males (77 beats/

min) and Mexican-American males (76

beats/min). Among females, both

non-Hispanic black females (79

beats/min) and Mexican-American

females (79 beats/min) have a

statistically significantly (p < 0.01)

lower mean RPR when compared with

non-Hispanic white females (80

beats/min).

Prevalence of tachycardia

and bradycardia

The NHANES 1999–2008

normative sample data for RPR in adults

aged 20 and over was used to estimate

the prevalence of abnormally fast heart

rate (tachycardia) and abnormally slow

heart rate (bradycardia). Both the

clinical consensus definition of

tachycardia (RPR greater than 100

beats/min) and bradycardia (RPR less

than 60 beats/min) and the revised

clinical guideline of tachycardia (RPR

greater than 90 beats/min) and

bradycardia (RPR less than 50 beats/

min) are presented (11–17). When using

the traditional clinical definitions, the

estimated prevalence of clinical

tachycardia in the normative sample is

1.3% (95% CI = 1.1–1.7), and the

prevalence of clinical bradycardia

among adult males is 15.2% (95% CI =

14.1–16.4). For adult females, the

overall prevalence of clinical

tachycardia in the normative sample is

1.9% (95% CI = 1.6–2.3) and the

prevalence of clinical bradycardia is

6.9% (95% CI = 6.2–7.8). By the

traditional clinical definitions, males

have higher age-adjusted odds (that is,

2.43; 95% CI = 2.09–2.83; p < 0.05) of

having bradycardia and lower ageadjusted odds (that is, .71; 95% CI =

0.52–0.97; p < 0.05) of having

tachycardia as compared with women.

A more detailed analysis of the

prevalence of clinical bradycardia and

tachycardia was performed in the four

adult age groups (20–39, 40–59, 60–79,

and 80 and over). For adult males, there

are no statistically significant differences

in the prevalence rates for either

bradycardia or tachycardia across the

four adult age groups. In contrast, there

are statistically significant differences in

frequency of bradycardia across the four

adult age groups for females

(Satterthwaite-adjusted chi-square =

p < 0.0001). The lowest frequency of

bradycardia is seen among females aged

20–39 (5.4%; 95% CI = 4.4–6.5) and

the highest rate is seen among females

aged 40–59 (8.5%; 95% CI = 7.4–9.7).

An additional analysis was

performed using the newer revised

clinical guidelines for tachycardia (RPR

greater than 90 beats/min) and

bradycardia (RPR less than 50 beats/

min). By these criteria, the estimated

prevalence of tachycardia among men in

the normative sample is 5.2% (95% CI

= 4.6–5.9), while the prevalence of

bradycardia is 1.6% (95% CI = 1.2–2.0).

Among adult females, the overall

prevalence of tachycardia is 8.4% (95%

CI = 7.6–9.2) and the prevalence of

bradycardia is 0.3% (95% CI = 0.1–0.5).

Overall, comparing males with females

and adjusting for the effect of age,

males have significantly higher odds

(that is, 6.38; 95% CI = 3.05–13.36;

p < 0.05) of having bradycardia and

lower odds (that is, 0.59; 95% = CI

0.52–0.68; p < 0.05) of having

tachycardia.

Using the revised clinical criteria, a

more detailed analysis of the prevalence

of bradycardia and tachycardia was

performed for the four adult age groups

(20–39, 40–59, 60–79, and 80 and

over). Among males, there are no

statistically significant differences in the

prevalence rates for either bradycardia

or tachycardia across the four adult age

groups. In contrast, there are statistically

significantly differences in frequency of

tachycardia across the four adult age

groups for females (Satterthwaiteadjusted chi-square = p < 0.0001). The

highest frequency of tachycardia is seen

among females aged 20–39 (9.7%; 95%

CI = 8.6–11.0), and the lowest rate is

seen among females aged 60–79 (7.1%;

95% CI = 5.5–9.1). Similar to adult

males, there are no statistically

significant differences in the prevalence

rates for bradycardia in females across

the four adult age groups.

Discussion

The tables and figures in this report

present updated, population-based

means, medians, selected percentiles,

and ranges for RPR in the United States,

based on a normative sample of children

and adults in NHANES 1999–2008.

These estimates are given by specific

age subgroups, sex, and the major U.S.

race and ethnicity groupings. The most

recent U.S. reference data published for

RPR is based on data from NHANES I

(1971–1975), which were collected

almost four decades ago (1,2). In

NHANES I, resting pulse for children

aged 1–5 years was obtained as a

seated, resting radial pulse rate rather

than being obtained by heart

auscultation as it was in NHANES

1999–2008. For NHANES I adults, only

results for those aged 25–74 were

published. These included RPR

estimates based on a seated, 30-second

resting radial pulse as was done in

NHANES 1999–2008, but NHANES I

also included a detailed 20% subsample

of RPR estimates taken from

electrocardiographic (ECG) tracings

obtained in the supine (recumbent)
National Health Statistics Reports n Number 41 n August 24, 2011 Page 11

position. However, the NHANES ECG

data were not used to produce U.S.

national prevalence estimates for RPR.

It was used solely for a multivariable

analytic study to identify the major

factors that influence RPR, so no

comparisons can be made between the

NHANES I ECG data and the current

study.

The general trends for childhood

and resting pulse demographic

subgroups such as age and sex appear

similar when the earlier NHANES I

reports are compared with the current

NHANES estimates. For example, the

figures from NHANES I demonstrating

the decline in RPR with increasing age

from infancy to adulthood are similar in

configuration to the current NHANES

figures (NHANES I figures not

presented). There are, however, some

apparent differences. The previous

NHANES I analysis shows no consistent

change in RPR between ages 25 and 74

for male and female participants. This

suggests that there was generally a

plateau in RPR across the entire adult

age range. The NHANES 1999–2008

data confirms the same pattern for adult

males, but shows a somewhat different

pattern for adult females. For females,

an apparent plateau in RPR is not

reached until later in life (ages 40–59).

In addition, the absolute magnitude of

estimates of RPR central tendency

appear to be systematically higher in the

NHANES I data than in the current

NHANES data. For example, mean RPR

for adult white males aged 25–74 during

NHANES I ranges from 77.4 to 79.8

beats/min, whereas during NHANES

1999–2008, normative sample mean

RPR in adult non-Hispanic white males

aged 20 and over ranges from 69 to 71

beats/min. The comparable ranges for

females are 80.1 to 81.8 during

NHANES I, and 73 to 76 beats/min

during NHANES 1999–2008. Other

patterns seen in the data appear similar

between the two surveys—for example,

there is a slightly higher RPR among

females when compared with males, and

a slightly higher RPR in non-Hispanic

whites when compared with other race

and ethnic groups.

The samples used in NHANES I

and in the current NHANES are

different. Specifically, in NHANES I,

estimates were based on almost the

entire examined population (only

pregnant women and a few outlier

observations were excluded). More

detailed exclusions or adjustments for

medication use and other variables in

the current analysis likely influenced the

RPR results for population subgroups

analyses. These more recent estimates

are based on a normative sample of the

U.S. population, excluding many

conditions that would cause secondary

variations in RPR, such as a current

infectious illness or certain prescription

medications that are known to influence

the resting heart rate. Another factor to

consider is that it is unclear if the

NHANES I resting pulse was measured

after an examinee had been seated and

resting quietly for approximately 4

minutes as was done in NHANES

1999–2008. There may be systematic

differences in the methodology used in

the two NHANES surveys resulting

from systematic differences in sample

selection and data collection protocols.

For example, whereas the current survey

reports categories by race and ethnicity,

NHANES I reported categories by race

only; furthermore, whereas race and

ethnicity is self-reported in the current

survey, race was reported by the

interviewer in NHANES I (18). The

basis for the NHANES I summary RPR

estimates thus was systematically

different from the current NHANES

1999–2008 estimates.

There are methodological

limitations associated with obtaining

RPR estimates in a cross-sectional study

such as NHANES, as in for example,

the onetime assessment of an

individual’s RPR, and reliance on

self-reported information for the

participant’s age and race and ethnicity

status. Although there was dedicated

examiner training and quality control

monitoring, the RPR data were obtained

manually and therefore are subject to

some degree of human error. Moreover,

the basic data for RPR was obtained as

a 30-second sample with the 30-second

pulse rate, then multiplied by two to

produce an RPR in beats per minute.

This process produces only even

numbers, which may result in less

precise results. The NHANES I RPR

obtained by electrocardiogram is

generally considered to be more precise;

however, it too was a calculated value.

For example in clinical practice, if the

heart rhythm is regular, the RPR is

calculated by an electrocardiogram by

measuring the time in tenths of a second

between two successive heartbeat wave

forms, and then adjusting this number to

produce an estimate of RPR in beats per

minute.

The NHANES I study used a

variation of this technique in which the

heart rate was calculated separately for

each of the 12 electrocardiographic

leads. These 12 values were then

averaged to produce a final summary

RPR measurement. The current RPR

estimates in the NHANES 1999–2008

study are, however, directly comparable

with the approach commonly used to

obtain RPRs in pediatric and adult

clinical practice in the United States,

and thus are potentially more relevant as

reference estimates. However, there is

increasing clinical use of automated

devices to measure both pulse and blood

pressure, and it is unclear how these

reference data would compare with RPR

data collected by these newer methods.

Finally, as was recently suggested by

Black et al., RPR is easily measured and

may provide valuable population-level

information on cardiac health (19).

Further limitations may exist,

specifically, NHANES 1999–2008 did

not collect body temperature

measurement, so we could not exclude

those who had febrile illnesses during

the exam. We also were unable to

exclude those persons currently taking

nonprescription medications that could

potentially affect the pulse rate, because

these data were not collected in

NHANES 1999–2008. Similarly, we did

not control for herbal medicines or

caffeinated beverages that could

transiently affect the heart rate. Finally,

while we constructed a ‘‘normative’’

sample for our analysis, it should not be

inferred that all individual examinees

selected for this subsample were in a

‘‘normal’’ state of health, as we were

unable, given the NHANES data

collection protocol, to exclude all
Page 12	 National Health Statistics Reports n Number 41 n August 24, 2011

potential medical illnesses that might

affect the RPR.

Conclusion

This report provides normative data

on RPR using a large, recently obtained,

population-based national sample. In

particular, the data on resting pulse from

NHANES 1999–2008 provide RPR

reference range estimates to update

those previously published using

NHANES I RPR data. The current

findings show that RPR decreases with

age for males and females. With the

exception of persons aged 80 and over,

the average female mean RPR was

higher than for males. The mean

difference between the adult gender

groups was 3 beats/min. While the

clinical relevance of such a difference

for an individual may be limited, it is

statistically significant (on a population

level it may, in fact, be important),

given that increases in RPR appear to be

an independent predictor for adult

cardiovascular disease. The current

finding that males, when compared with

females, were twice as likely to have

bradycardia and almost 30% less likely

to have tachycardia by traditional

clinical criteria was significant. These

differences are more pronounced if the

recently proposed clinical guidelines are

employed. These results, and the finding

that self-reported race and ethnicity has

a small but significant effect on mean

RPR, could potentially also be of public

health importance. However, further

confirmations of the findings in this

report are needed before the public

health significance of these findings can

be properly assessed.

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guidelines.htm.

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National Health Statistics Reports

n Number 41n August 24, 2011 Page 13

tional resting pulse rate: National Health and Nutrition Examination Survey, 1999–2008

Percentile

SE

Mean mean 1st 2.5th 5th 10th 25th 50th 75th 90th 95th 97.5th 99th

129 0.9 90 99 103 108 116 126 137 149 156 162 174

118 0.7 83 91 95 100 108 116 123 133 138 145 158

107 0.4 78 82 86 90 97 105 113 119 124 131 138

96 0.5 70 72 75 79 86 94 102 110 114 119 126

87 0.3 60 64 68 71 78 85 93 101 105 109 11683 0.4 57 60 63 67 73 81 89 96 101 106 11278 0.3 52 56 58 62 68 76 85 93 98 103 108

75 0.3 48 51 54 58 64 73 82 90 95 101 105

73 0.2 48 51 54 57 64 71 79 87 92 98 103

72 0.2 47 51 54 57 62 70 78 86 91 96 102

72 0.3 47 50 54 56 62 69 77 85 91 97 102

72 0.7 † 51 54 57 62 70 77 86 93 98 101

with a current medical condition or medication use that would affect the resting pulse rate.

for U.S. males, by age group: National Health and Nutrition Examination Survey, 1999–2008

Percentile

SE

Mean mean 1st 2.5th 5th 10th 25th 50th 75th 90th 95th 97.5th 99th

128 1.1 84 98 102 107 115 125 137 148 155 160 171

116 0.8 † 91 95 100 107 114 122 131 137 146 156

106 0.4 75 82 85 89 96 104 112 119 124 131 139

94 0.6 69 71 74 78 84 92 100 108 112 116 120

86 0.5 59 63 66 70 76 83 92 100 105 109 114

80 0.5 56 59 61 66 70 78 86 94 97 102 110

77 0.4 52 54 57 60 66 74 83 91 97 102 108

72 0.4 46 50 52 56 61 69 78 87 92 95 104

71 0.3 47 50 52 55 61 69 76 84 89 95 101

71 0.3 46 49 52 55 61 68 77 85 90 95 104

70 0.5 45 48 50 54 60 67 75 84 91 98 10271 1.1 † 48 51 54 61 68 78 86 94 97 †

with a current medical condition or medication use that would affect the resting pulse rate.
for U.S. females, by age group: National Health and Nutrition Examination Survey, 1999–2008

Percentile

SE

Mean mean 1st 2.5th 5th 10th 25th 50th 75th 90th 95th 97.5th 99th

130 1 96 99 104 108 118 127 137 150 156 163 174

119 0.8 82 92 95 101 110 117 125 135 139 143 158

108 0.5 78 83 88 91 98 107 114 120 125 130 137

97 0.6 70 73 76 81 87 95 104 110 117 122 13288 0.5 61 66 69 73 79 87 94 101 106 109 117

85 0.5 58 63 66 69 76 83 91 98 103 107 11380 0.4 54 57 60 63 70 79 87 94 99 103 110

79 0.4 50 54 58 62 69 77 85 94 99 103 108

76 0.3 52 55 57 60 66 74 82 89 95 99 104

73 0.3 51 53 56 59 64 71 79 86 92 97 101

73 0.4 52 54 56 59 64 70 78 86 92 96 102

73 0.9 † 53 56 59 64 71 77 85 93 98 100

with a current medical condition or medication use that would affect the resting pulse rate.

Page 14 National Health Statistics Reportsn Number 41n August 24, 2011
of U.S. males, by race and ethnicity: National Health and Nutrition Examination Survey, 1999–2008

Percentile

SE

Mean mean 1st 2.5th 5th 10th 25th 50th 75th 90th 95th 97.5th 99th

128 1.2 95 101 106 110 116 124 136 149 158 161 †

117 1.1 † 91 94 99 108 115 122 132 140 154 †

104 0.6 † 80 84 87 94 102 110 115 121 124 132

95 1.0 † 70 74 77 84 93 101 110 114 120 †

87 0.7 60 63 66 69 76 84 92 103 109 115 12082 0.6 56 61 64 66 72 80 88 94 98 103 105

76 0.6 50 56 57 60 66 74 82 90 96 100 108

72 0.5 49 51 54 57 62 68 77 86 91 95 100

70 0.5 47 50 52 55 61 67 75 83 88 95 102

70 0.4 47 50 53 55 60 68 76 84 90 94 101

70 0.6 47 50 52 54 59 65 76 84 90 93 102

66 2.2 § † † 59 65 69 75 80 † § §

128 1.5 † 98 102 107 115 125 138 148 156 161 †

117 1.2 † 91 95 102 107 114 122 132 138 † †

106 0.6 82 83 87 90 96 104 112 120 126 133 139

94 0.8 70 71 74 78 84 92 99 107 112 115 118

86 0.7 † 63 67 70 77 84 93 101 104 109 †

80 0.5 † 59 63 66 71 78 85 94 98 102 †

78 0.6 53 56 58 62 68 76 84 92 98 102 109

73 0.6 47 49 53 56 62 70 80 88 93 97 103

71 0.4 46 50 53 56 62 69 77 85 89 95 100

71 0.4 46 49 52 55 61 69 77 85 91 96 104

69 0.6 44 47 50 54 60 67 75 83 90 98 101

71 1.2 § † 52 55 61 67 78 86 94 98 †

129 1.4 † 98 104 110 116 125 138 149 158 160 †

115 1.0 § † 92 99 106 112 121 130 134 140 †

103 0.8 § 74 79 86 95 102 110 117 122 126 †

92 0.8 † 70 74 77 82 89 97 105 110 117 †

83 0.7 † 62 64 67 73 80 88 97 101 105 113

78 0.6 53 56 58 62 69 76 84 90 93 96 99

72 0.4 † 52 54 57 63 70 78 86 89 93 98

67 0.5 45 48 51 53 58 65 72 79 83 88 95

69 0.4 † 50 51 54 59 66 75 83 88 93 102

70 0.5 45 48 53 55 60 68 77 84 89 93 9972 1.0 † † 48 54 60 68 79 89 98 105 †

68 2.3 § § § † 57 67 76 † † § §

with a current medical condition or medication use that would affect the resting pulse rate.

National Health Statistics Reportsn Number 41n August 24, 2011 Page 15
Page 16 National Health Statistics Reports

n Number 41n August 24, 2011

of U.S. females, by race and ethnicity: National Health and Nutrition Examination Survey, 1999–2008

Percentile

SE

Mean mean 1st 2.5th 5th 10th 25th 50th 75th 90th 95th 97.5th 99th

129 1.4 87 100 106 108 116 125 137 150 157 163 167

119 1.3 † 95 97 99 107 116 126 139 146 † §

107 0.7 † 82 86 89 96 106 114 122 127 136 †

97 0.7 70 75 78 82 87 95 103 111 116 120 127

88 0.8 † 68 71 72 78 86 94 103 108 111 11386 0.7 60 64 66 70 76 83 91 100 105 109 113

79 0.5 56 58 61 64 70 76 85 93 97 103 107

77 0.5 48 53 58 62 68 75 83 90 94 98 105

75 0.4 52 56 58 60 66 72 80 87 92 99 103

73 0.7 47 53 56 59 64 70 77 85 90 92 †

73 0.6 † 54 56 59 64 70 77 87 94 100 †

75 2.4 § † † 62 67 72 76 92 † † §

131 1.5 † 100 106 109 119 127 138 151 156 164 †120 1.0 † 92 96 103 110 118 126 135 139 † †

109 0.8 78 82 87 94 100 107 114 120 126 131 137

97 0.9 † 71 76 80 87 96 104 110 118 122 †

89 0.7 59 66 70 73 81 88 94 102 106 109 †

86 0.7 58 63 66 70 77 84 91 98 103 107 †

81 0.6 55 58 60 63 71 80 88 95 100 104 110

79 0.6 50 53 57 61 70 77 86 95 100 103 110

76 0.3 52 54 57 60 67 74 82 91 96 100 10773 0.4 52 53 56 58 64 71 79 87 93 97 101

73 0.4 52 54 56 59 64 70 78 86 91 97 103

73 1.1 † 52 56 58 64 71 77 85 93 † §

130 1.5 † 100 105 110 115 128 139 153 159 † §

117 1.2 † † 95 101 108 118 123 131 138 140 †

107 0.7 § † 87 90 97 105 112 119 123 127 135

95 0.8 § † 75 78 86 94 101 108 111 115 †

87 0.7 † 65 67 72 78 85 93 101 105 108 112

82 0.8 † 60 63 67 72 80 88 96 101 105 †

78 0.4 52 56 60 62 68 76 84 91 95 99 103

77 0.5 † 54 56 60 68 75 83 91 95 99 10776 0.4 53 55 58 61 67 74 81 88 94 97 103

74 0.5 † 53 56 59 65 71 80 87 92 96 99

74 0.8 † 52 55 58 64 71 79 88 95 100 †

72 2.6 § § † † 63 68 73 † † § §

with a current medical condition or medication use that would affect the resting pulse rate.
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National Health Statistics Reports n Number 41 n August 24, 2011

Acknowledgments

We would like to express our gratitute to Michele Chiappa, Technical Writer, Harris Corpoarion, for the review and initial editng of the various

drafts of this report.

Suggested citation

Ostchega Y, Porter KS, Hughes J, Dillion CF,

Nwankwo T. Resting pulse rate reference data

for children, adolescents, and adults: United

States, 1999–2008. National health statistics

reports; no 41. Hyattsville, MD: National

Center for Health Statistics. 2011.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director 

Jennifer H. Madans, Ph.D., Associate Director 

for Science 

Division of Health and Nutrition 

Examination Surveys 

Clifford L. Johnson, M.S.P.H., Director

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