Diastolic dysfunction is present in half of patients with
hypertension and has been shown to be associated with increased cardiovascular morbidity and mortality, as well as the development of
heart failure. With the high prevalence of
hypertension and its associated complications, treatment of diastolic dysfunction in
hypertension is an important and desirable goal.
Angiotensin converting enzyme inhibitors and
angiotensin receptor blockers have been shown to be effective in improvement of measures of diastolic function and are recommended as first-line agents in the control of
hypertension in patients with
diastolic heart failure. Beta-
blockers, calcium channel blockers, and
diuretics have also shown some efficacy in improved indices of diastolic filling. However, the independent impact of these pharmacologic interventions on prognosis and outcome in diastolic dysfunction has yet to be clarified. The
Irbesartan in
Heart Failure with Preserved Ejection Fraction (I-PRESERVE) study,
Candesartan in
Heart Failure: Assessment in Reduction of Mortality and Morbidity (CHARM-Preserved) trial and the
Losartan Intervention For End-point Reduction in
Hypertension (LIFE) Study all failed to show improved morbidity and mortality with these drugs although, the LIFE study showed reduced
heart failure hospitalization in hypertensive patients with normal in-treatment diastolic function. The Trial Of Preserved Cardiac function
heart failure with an
Aldosterone anTagonist (TOPCAT) is an on-going large, international study evaluating the effect of
spironolactone on cardiovascular mortality, aborted
cardiac arrest, or hospitalization for
diastolic heart failure. This and other studies will provide further insight into the pathophysiology and management of patients with diastolic dysfunction.