Effect of diuretic or calcium-channel blocker plus angiotensin-receptor blocker on diastolic function in hypertensive patients

Norihisa Toh; Katsuhisa Ishii; Hajime Kihara; Katsuomi Iwakura; Hiroyuki Watanabe; Junichi Yoshikawa; Hiroshi Ito; Shin Takiuchi; Naoto Tokunaga; Masayasu Kusaka; Fumiaki Nakamura; Shota Fukuda; Yukio Abe; Yoshinori Tani; Atsuko Furukawa; Yasuki Hen; Miho Kawaguchi; Shigeki Mori; Noriaki Kasayuki; Hiroki Nishioka; Yasuji Doi; Masashi Ikushima; Kenichiro Suwa; Kei Tawarahara; Ritsuko Terasaka; Natsuki Takahashi; Yasuyo Takeuchi; Taro Minagawa; Hiroyuki Takase; Toshihiko Nagano; Yoshimune Hiramoto; Masahiro Izumi; Takahisa Yamada; Hideki Fujio; Takeshi Takami; Masahiro Yoshida; Hiroki Oe; Yasuhiro Akazawa; Takashi Murakami

doi:10.1253/circj.CJ-15-0815

Effect of diuretic or calcium-channel blocker plus angiotensin-receptor blocker on diastolic function in hypertensive patients

Norihisa Toh, Katsuhisa Ishii, Hajime Kihara, Katsuomi Iwakura, Hiroyuki Watanabe, Junichi Yoshikawa, Hiroshi Ito, Shin Takiuchi, Naoto Tokunaga, Masayasu Kusaka, Fumiaki Nakamura, Shota Fukuda, Yukio Abe, Yoshinori Tani, Atsuko Furukawa, Yasuki Hen, Miho Kawaguchi, Shigeki Mori, Noriaki Kasayuki, Hiroki NishiokaYasuji Doi, Masashi Ikushima, Kenichiro Suwa, Kei Tawarahara, Ritsuko Terasaka, Natsuki Takahashi, Yasuyo Takeuchi, Taro Minagawa, Hiroyuki Takase, Toshihiko Nagano, Yoshimune Hiramoto, Masahiro Izumi, Takahisa Yamada, Hideki Fujio, Takeshi Takami, Masahiro Yoshida, Hiroki Oe, Yasuhiro Akazawa, Takashi Murakami

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Background: Hypertension increases the risk of left ventricular (LV) diastolic dysfunction, and anti-hypertensive therapy may improve LV relaxation. The aim of this study was to investigate whether combining an angiotensinreceptor blocker (ARB) with either hydrochlorothiazide (HCTZ) or a calcium-channel blocker (CCB) improves LV relaxation in patients with hypertension and diastolic dysfunction. Methods and Results: Hypertensive patients who had not achieved their target blood pressure with at least 4 weeks of ARB therapy were randomly assigned to receive either a fixed-dose combination of losartan and HCTZ (losartan/HCTZ; n=110) or a combination of amlodipine and a typical ARB dosage (CCB/ARB; n=121) and followed for 24 weeks. The primary endpoint was change in early diastolic mitral annular velocity (e’, cm/s). Systolic blood pressure decreased in both groups after switch to the combination therapies. E’ velocity increased both in the losartan/ HCTZ (0.52 cm/s) and in the CCB/ARB (0.59 cm/s) groups. The mean (95% CI) treatment difference was −0.02 (−0.37 to 0.34) cm/s, indicating that improvement in LV relaxation was similar between the groups. The ratio of early mitral inflow velocity to e’ velocity and left atrial volume index were significantly decreased in the losartan/HCTZ group. Conclusions: The combination of losartan and HCTZ is as effective as amlodipine plus ARB in improving LV relaxation in hypertensive patients.

Original language	English
Pages (from-to)	426-434
Number of pages	9
Journal	Circulation Journal
Volume	80
Issue number	2
DOIs	https://doi.org/10.1253/circj.CJ-15-0815
Publication status	Published - Jan 25 2016

Keywords

Diastolic function
Echocardiography
Heart failure
Hemodynamics
Hypertension

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1253/circj.CJ-15-0815

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Toh, N., Ishii, K., Kihara, H., Iwakura, K., Watanabe, H., Yoshikawa, J., Ito, H., Takiuchi, S., Tokunaga, N., Kusaka, M., Nakamura, F., Fukuda, S., Abe, Y., Tani, Y., Furukawa, A., Hen, Y., Kawaguchi, M., Mori, S., Kasayuki, N., ... Murakami, T. (2016). Effect of diuretic or calcium-channel blocker plus angiotensin-receptor blocker on diastolic function in hypertensive patients. Circulation Journal, 80(2), 426-434. https://doi.org/10.1253/circj.CJ-15-0815

Toh, N, Ishii, K, Kihara, H, Iwakura, K, Watanabe, H, Yoshikawa, J, Ito, H, Takiuchi, S, Tokunaga, N, Kusaka, M, Nakamura, F, Fukuda, S, Abe, Y, Tani, Y, Furukawa, A, Hen, Y, Kawaguchi, M, Mori, S, Kasayuki, N, Nishioka, H, Doi, Y, Ikushima, M, Suwa, K, Tawarahara, K, Terasaka, R, Takahashi, N, Takeuchi, Y, Minagawa, T, Takase, H, Nagano, T, Hiramoto, Y, Izumi, M, Yamada, T, Fujio, H, Takami, T, Yoshida, M, Oe, H, Akazawa, Y & Murakami, T 2016, 'Effect of diuretic or calcium-channel blocker plus angiotensin-receptor blocker on diastolic function in hypertensive patients', Circulation Journal, vol. 80, no. 2, pp. 426-434. https://doi.org/10.1253/circj.CJ-15-0815

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title = "Effect of diuretic or calcium-channel blocker plus angiotensin-receptor blocker on diastolic function in hypertensive patients",

abstract = "Background: Hypertension increases the risk of left ventricular (LV) diastolic dysfunction, and anti-hypertensive therapy may improve LV relaxation. The aim of this study was to investigate whether combining an angiotensinreceptor blocker (ARB) with either hydrochlorothiazide (HCTZ) or a calcium-channel blocker (CCB) improves LV relaxation in patients with hypertension and diastolic dysfunction. Methods and Results: Hypertensive patients who had not achieved their target blood pressure with at least 4 weeks of ARB therapy were randomly assigned to receive either a fixed-dose combination of losartan and HCTZ (losartan/HCTZ; n=110) or a combination of amlodipine and a typical ARB dosage (CCB/ARB; n=121) and followed for 24 weeks. The primary endpoint was change in early diastolic mitral annular velocity (e{\textquoteright}, cm/s). Systolic blood pressure decreased in both groups after switch to the combination therapies. E{\textquoteright} velocity increased both in the losartan/ HCTZ (0.52 cm/s) and in the CCB/ARB (0.59 cm/s) groups. The mean (95% CI) treatment difference was −0.02 (−0.37 to 0.34) cm/s, indicating that improvement in LV relaxation was similar between the groups. The ratio of early mitral inflow velocity to e{\textquoteright} velocity and left atrial volume index were significantly decreased in the losartan/HCTZ group. Conclusions: The combination of losartan and HCTZ is as effective as amlodipine plus ARB in improving LV relaxation in hypertensive patients.",

keywords = "Diastolic function, Echocardiography, Heart failure, Hemodynamics, Hypertension",

author = "Norihisa Toh and Katsuhisa Ishii and Hajime Kihara and Katsuomi Iwakura and Hiroyuki Watanabe and Junichi Yoshikawa and Hiroshi Ito and Shin Takiuchi and Naoto Tokunaga and Masayasu Kusaka and Fumiaki Nakamura and Shota Fukuda and Yukio Abe and Yoshinori Tani and Atsuko Furukawa and Yasuki Hen and Miho Kawaguchi and Shigeki Mori and Noriaki Kasayuki and Hiroki Nishioka and Yasuji Doi and Masashi Ikushima and Kenichiro Suwa and Kei Tawarahara and Ritsuko Terasaka and Natsuki Takahashi and Yasuyo Takeuchi and Taro Minagawa and Hiroyuki Takase and Toshihiko Nagano and Yoshimune Hiramoto and Masahiro Izumi and Takahisa Yamada and Hideki Fujio and Takeshi Takami and Masahiro Yoshida and Hiroki Oe and Yasuhiro Akazawa and Takashi Murakami",

year = "2016",

month = jan,

day = "25",

doi = "10.1253/circj.CJ-15-0815",

language = "English",

volume = "80",

pages = "426--434",

journal = "Circulation Journal",

issn = "1346-9843",

publisher = "Japanese Circulation Society",

number = "2",

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T1 - Effect of diuretic or calcium-channel blocker plus angiotensin-receptor blocker on diastolic function in hypertensive patients

AU - Toh, Norihisa

AU - Ishii, Katsuhisa

AU - Kihara, Hajime

AU - Iwakura, Katsuomi

AU - Watanabe, Hiroyuki

AU - Yoshikawa, Junichi

AU - Ito, Hiroshi

AU - Takiuchi, Shin

AU - Tokunaga, Naoto

AU - Kusaka, Masayasu

AU - Nakamura, Fumiaki

AU - Fukuda, Shota

AU - Abe, Yukio

AU - Tani, Yoshinori

AU - Furukawa, Atsuko

AU - Hen, Yasuki

AU - Kawaguchi, Miho

AU - Mori, Shigeki

AU - Kasayuki, Noriaki

AU - Nishioka, Hiroki

AU - Doi, Yasuji

AU - Ikushima, Masashi

AU - Suwa, Kenichiro

AU - Tawarahara, Kei

AU - Terasaka, Ritsuko

AU - Takahashi, Natsuki

AU - Takeuchi, Yasuyo

AU - Minagawa, Taro

AU - Takase, Hiroyuki

AU - Nagano, Toshihiko

AU - Hiramoto, Yoshimune

AU - Izumi, Masahiro

AU - Yamada, Takahisa

AU - Fujio, Hideki

AU - Takami, Takeshi

AU - Yoshida, Masahiro

AU - Oe, Hiroki

AU - Akazawa, Yasuhiro

AU - Murakami, Takashi

PY - 2016/1/25

Y1 - 2016/1/25

N2 - Background: Hypertension increases the risk of left ventricular (LV) diastolic dysfunction, and anti-hypertensive therapy may improve LV relaxation. The aim of this study was to investigate whether combining an angiotensinreceptor blocker (ARB) with either hydrochlorothiazide (HCTZ) or a calcium-channel blocker (CCB) improves LV relaxation in patients with hypertension and diastolic dysfunction. Methods and Results: Hypertensive patients who had not achieved their target blood pressure with at least 4 weeks of ARB therapy were randomly assigned to receive either a fixed-dose combination of losartan and HCTZ (losartan/HCTZ; n=110) or a combination of amlodipine and a typical ARB dosage (CCB/ARB; n=121) and followed for 24 weeks. The primary endpoint was change in early diastolic mitral annular velocity (e’, cm/s). Systolic blood pressure decreased in both groups after switch to the combination therapies. E’ velocity increased both in the losartan/ HCTZ (0.52 cm/s) and in the CCB/ARB (0.59 cm/s) groups. The mean (95% CI) treatment difference was −0.02 (−0.37 to 0.34) cm/s, indicating that improvement in LV relaxation was similar between the groups. The ratio of early mitral inflow velocity to e’ velocity and left atrial volume index were significantly decreased in the losartan/HCTZ group. Conclusions: The combination of losartan and HCTZ is as effective as amlodipine plus ARB in improving LV relaxation in hypertensive patients.

AB - Background: Hypertension increases the risk of left ventricular (LV) diastolic dysfunction, and anti-hypertensive therapy may improve LV relaxation. The aim of this study was to investigate whether combining an angiotensinreceptor blocker (ARB) with either hydrochlorothiazide (HCTZ) or a calcium-channel blocker (CCB) improves LV relaxation in patients with hypertension and diastolic dysfunction. Methods and Results: Hypertensive patients who had not achieved their target blood pressure with at least 4 weeks of ARB therapy were randomly assigned to receive either a fixed-dose combination of losartan and HCTZ (losartan/HCTZ; n=110) or a combination of amlodipine and a typical ARB dosage (CCB/ARB; n=121) and followed for 24 weeks. The primary endpoint was change in early diastolic mitral annular velocity (e’, cm/s). Systolic blood pressure decreased in both groups after switch to the combination therapies. E’ velocity increased both in the losartan/ HCTZ (0.52 cm/s) and in the CCB/ARB (0.59 cm/s) groups. The mean (95% CI) treatment difference was −0.02 (−0.37 to 0.34) cm/s, indicating that improvement in LV relaxation was similar between the groups. The ratio of early mitral inflow velocity to e’ velocity and left atrial volume index were significantly decreased in the losartan/HCTZ group. Conclusions: The combination of losartan and HCTZ is as effective as amlodipine plus ARB in improving LV relaxation in hypertensive patients.

KW - Diastolic function

KW - Echocardiography

KW - Heart failure

KW - Hemodynamics

KW - Hypertension

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U2 - 10.1253/circj.CJ-15-0815

DO - 10.1253/circj.CJ-15-0815

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VL - 80

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JO - Circulation Journal

JF - Circulation Journal

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ER -

Effect of diuretic or calcium-channel blocker plus angiotensin-receptor blocker on diastolic function in hypertensive patients

Abstract

Keywords

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