Treatment of Isolated Left Ventricular Diastolic Dysfunction in Hypertension

Abstract

A rterial hypertension is a major risk factor for congestive heart failure. Left ventricular (LV) hypertrophy is often associated with arterial hypertension and characterizes subjects with a particularly elevated risk of untoward cardiovascular events, including heart failure. 1 LV hypertrophy is, in turn, associated with impaired LV myocardial contractility and LV diastolic dysfunction. LV hypertrophy, impaired LV myocardial contractility, and LV diastolic dysfunction predict heart failure in population-based studies. 2,3 Subjects with heart failure but with normal LV ejection fraction, that is, with diastolic heart failure, exhibit abnormal LV diastolic function. 4 However, Doppler parameters of LV diastolic function may be abnormal in the absence of overt heart failure. Such a condition, called "isolated LV diastolic dysfunction," bears independent prognostic significance in population-based and clinical studies. 2,3,5 Thus, regression of isolated LV diastolic dysfunction may be considered an important therapeutic target in hypertension.In the general adult population without congestive heart failure, Ϸ30% may show LV diastolic dysfunction of any degree. 6 In high-risk subgroups (patients Ͼ65 years of age, those with hypertension, and those with LV hypertrophy), the prevalence of isolated LV diastolic dysfunction rises to 60 -80%. 7 On the other hand, LV diastolic dysfunction may be found in Ϸ26% of hypertensive subjects without LV hypertrophy and with normal myocardial contractility. 8 LV hypertrophy regression, proven to be protective in hypertension, 9 is a major determinant of LV diastolic dysfunction regression in hypertensive subjects. 7 However, it remains to be explored whether isolated LV diastolic dysfunction regression would impact independently on cardiovascular prevention in arterial hypertension.In the present issue of Hypertension, Solomon et al 10 focused on isolated LV diastolic dysfunction regression in hypertension using a novel study design. The large majority of the participants in the study by Solomon et al 10 had impaired LV relaxation, which was more prevalent than LV hypertrophy. The study tested the hypothesis that lower in-treatment blood pressure (BP) target could result in greater LV diastolic dysfunction regression. Accordingly, Doppler parameters of LV diastolic function were compared between a regimen defined "intensive," because of a predefined systolic BP (SBP) target of Ͻ130 mm Hg, and a second regimen defined "standard," because of a prespecified SBP target of Ͻ140 mm Hg. Combinations of valsartan, either 160 or 320 mg, plus amlodipine, either 5 or 10 mg, were used; additional antihypertensive medications were added if needed to reach the BP targets. The main finding of the study was that changes in Doppler parameters of LV diastolic function were comparable, on average, between the 2 treatment arms. Hence, on the matter of the impact of aggressive or standard antihypertensive treatment on LV diastolic dysfunction regression, there is apparently no good news.However, the st...

The association and predictive value analysis of metabolic syndrome on diastolic heart failure in patients at high risk for coronary artery disease

“…This finding is inconsistent with those of some earlier studies, which had revealed that BMI, SBP, DBP and lipid profiles were significantly associated with diastolic parameters and the structure and functions of the LV [4,16-18,20]. In the present study, BMI, FPG and HDL were not significantly associated with DHF.…”

“…This finding is of special importance if the direct relationship between MetS and DHF is considered. The clustering of cardiovascular risk factors in MetS indicates that the multiple complex metabolic reactions involved in glycotoxicity, lipotoxicity, altered insulin signaling, increased cytokine activity and interstitial deposition of triacylglycerol may directly or indirectly impact myocardial function [4,16-20]. Additionally, these metabolic risk factors lead to reduced energy availability, and have an additive, adverse effect on endothelial function [21].…”

“…The results were confirmed in the MLR analysis with BP as a binary variable. DBP has been found to be an important predictor of LV diastolic dysfunction or DHF [20,22]. DBP can directly influence diastolic function and remodel the LV structure, leading to DHF [23].…”

Association and Predictive Value Analysis for Resting Heart Rate and Diabetes Mellitus on Cardiovascular Autonomic Neuropathy in General Population

“…Our previous study [13] and other previous studies [15–17] reported that DM and resting HR are significantly associated with CA function indices. Generally, increased resting HR was considered one of early indicators of CAN.…”

Pre-Clinical Diastolic Dysfunction

“…(62) Indeed, these studies suggested that good hypertension control may lead to regression of PDD, although this requires further validation. (63) As discussed in the natural history section, diabetes contributes to progression of diastolic dysfunction. Iribarren et al demonstrated that among those with diabetes, poor glycemic control may be associated with the development of heart failure, suggesting the importance of diabetes treatment for the prevention of diastolic dysfunction progression.…”