Can Treating Hypertension Improve Diastolic Dysfunction?

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 with the right kind of medication.

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. People with hypertension are particularly likely to develop heart muscle "hypertrophy" (thickening), which causes diastolic dysfunction.

Here is what UpToDate, an electronic reference for doctors and patients, has to say about the ability of various kinds of blood pressure medications to reduce hypertrophy of the left ventricle (LVH), and therefore, to reduce diastolic dysfunction:

"A meta-analysis published in 2003 attempted to evaluate the relative efficacy of different antihypertensive drugs for their ability to reverse LVH in patients with hypertension [22]. Eighty trials that included 146 and 17 active treatment and placebo arms, respectively, were evaluated. After statistical adjustments for length of therapy and degree of blood pressure lowering, the relative reductions in left ventricular mass index were:
  • Angiotensin II receptor blockers (ARBs) - 13 percent
  • Calcium channel blockers - 11 percent
  • ACE inhibitors - 10 percent
  • Diuretics - 8 percent
  • Beta blockers - 6 percent"

In other words, based on an analysis of a number of published studies, it appears that some blood pressure medicines -- ARBs, calcium channel blockers, and ACE inhibitors -- may be better than others in reducing the amount of cardiac hypertrophy, and therefore the amount of diastolic dysfunction.

    Notably, this analysis does not actually prove that using one of these drugs leads to "better" clinical outcomes than using, say, diuretics or beta blockers in patients with diastolic dysfunction. It merely suggests that certain kinds of drugs may be more effective than others in reversing the hypertrophy that causes diastolic dysfunction. The really important thing, most experts believe, is to get control of the blood pressure using whatever types of medicines are best tolerated and most effective for an individual patient.

    The bottom line is that your doctor appears to be giving you very good medical advice, and you should work with her to get that blood pressure under control.

    Want to learn more? See UpToDate's topic, "High Blood Pressure Treatment in Adults," for additional in-depth medical information.

    Source:

    Zile MR, Colluci WS. Treatment and prognosis of diastolic heart failure. UpToDate. Accessed May, 2011.

    Continue Reading