Can Treating Hypertension Improve Diastolic Dysfunction?

Checking blood pressure
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Question: Can Treating Hypertension Improve Diastolic Dysfunction?

I have been told by my doctor that I have a condition called "diastolic dysfunction." She says that it may be caused by my high blood pressure, and wants me to start on a new medicine for blood pressure control. Is it true that lowering my blood pressure can improve my heart condition, and if so, what kind of blood pressure medication should I be on?

Answer: Your doctor is correct, and you should work with her to get your blood pressure controlled. Read on to see why.

DIastolic Dysfunction and Hypertension

Diastolic dysfunction is a form of cardiac disease in which the heart muscle becomes relatively "stiff," which reduces the heart's ability to fill with blood in between heart beats. Diastolic dysfunction is associated with several conditions including hypertensionhypertrophic cardiomyopathyaortic stenosiscoronary artery diseasediabetes, obesity, and a sedentary lifestyle. If diastolic dysfunction becomes severe enough, heart failure can develop eventually. 

People with hypertension are particularly likely to develop thickening of the heart muscle — a condition called “hypertrophy" — that leads to diastolic dysfunction. Furthermore, just as your doctor has told you, treating hypertension has been shown to reduce the risk of developing heart failure from diastolic dysfunction.


In fact, certain drugs used to treat hypertension have been shown to actually reverse hypertrophy of the heart muscle, and reverse diastolic dysfunction.

Which Antihypertensive Drugs Are “Best” For Diastolic Dysfunction?

There are many, many drugs to choose from in treating hypertension, and not all of them are equally effective in improving diastolic dysfunction.

Many clinical trials have been conducted over the years to figure out which antihypertensive medications are most likely to reverse hypertrophy, and therefore, to reduce diastolic dysfunction:

A meta-analysis which included 80 clinical trials synthesized the results of these efforts. While all the major classes of drugs used to treat hypertension were effective in reducing cardiac hypertrophy, the classes that were most effective in this regard were:

Drugs in these classes reduced cardiac hypertrophy by between 10 - 13%. So, based on a large number of published studies, these three classes of drugs were particularly effective in reversing the condition that leads to diastolic dysfunction. Diuretics and beta blockers — the other two major classes of drugs commonly used to treat hypertension — also tended to reverse hypertrophy, but to a lesser degree.

While these results are intriguing, we should note that these particular studies were not designed to actually detect any differences in clinical outcomes among these drugs — just differences in their effect on hypertrophy.

It is presumed, but not proven, that reducing cardiac hypertrophy in people with diastolic dysfunction will lead to better outcomes.

The Bottom Line

Diastolic dysfunction is an important condition that can lead to heart failure. Because hypertension (along with obesity, sedentary living, and other factors) often produces diastolic dysfunction, effectively treating hypertension may also partially reverse diastolic dysfunction. The fact that certain antihypertensive drugs may be better at reversing hypertrophy than others is something doctors should take into account when prescribing hypertension therapy. 

So your doctor appears to be giving you very good medical advice, and you should work with her to get your blood pressure under control. However, keep in mind that effectively treating hypertension is the most important thing. If this can be done with the drugs that are better at reducing hypertrophy, great. But if not, what’s really important is getting control of your blood pressure, with whichever drug or drugs are the most effective and best tolerated in your own individual case. 


Davis BR, Kostis JB, Simpson LM, et al. Heart Failure With Preserved and Reduced Left Ventricular Ejection Fraction in the Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial. Circulation 2008; 118:2259.

Klingbeil AU, Schneider M, Martus P, et al. A Meta-analysis of the Effects of Treatment on Left Ventricular Mass in Essential Hypertension. Am J Med 2003; 115:41.

Schwartzenberg S, Redfield MM, From AM, et al. Effects of Vasodilation in Heart Failure with Preserved or Reduced Ejection Fraction Implications of Distinct Pathophysiologies on Response to Therapy. J Am Coll Cardiol 2012; 59:442.

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