Changes in left ventricular relaxation after azelnidipine treatment in hypertensive patients with diabetes: Subanalysis of a prospective single-arm multicentre study

Objectives: We previously demonstrated that a calcium channel blocker, azelnidipine, improves left ventricular relaxation in patients with hypertension and diastolic dysfunction in a multicentre, Clinical impact of Azelnidipine on Left VentricuLar diastolic function and OutComes in patients with hypertension (CALVLOC) trial. The objectives of the present subanalysis were to investigate the differences in diastolic function in hypertensive patients with and without diabetes, and the efficacy of azelnidipine on diastolic function among them.

Design: Subanalysis of a prospective single-arm multicentre study.

Participants: 228 hypertensive patients with normal ejection fraction and impaired left ventricular relaxation (septal e0 velocity <8 cm/s on echocardiography) enrolled for CALVLOC trial. They were divided into two groups based on presence or absence of diabetes.

Interventions: Administration of 16 mg of azelnidipine for 8 months (range 610 months).

Main outcome measures: Septal e0 velocity before and at the end of the study.

Results: Whereas patients with diabetes (n=53, 23.2%) had lower systolic blood pressure (BP) than patients without diabetes (155±17 vs 161±16 mm Hg, p=0.03), they had lower e′ velocity (5.7±1.5 vs 6.1 ±1.4 cm/s, p=0.04) at baseline. Azelnidipine decreased BP and heart rate, and increased e0 velocity similarly in patients with diabetes (5.7±1.5 to 6.3±1.5 cm/s, p=0.0003) and without diabetes (6.1±1.4 to 6.9 ±1.4 cm/s, p<0.0001). Increase in e0 velocity was not influenced by presence of diabetes, and patients with diabetes still had lower e′ velocity after treatment (p=0.006). There was a significant correlation between increase in e0 velocity and decrease in systolic BP (R=0.25, p=0.0001), which was not influenced by diabetes.

Conclusions: Comorbid diabetes could impair left ventricular relaxation independently in patients with hypertension, which might not be improved solely by BP lowering.