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 journalArticlepeer-review

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 languageEnglish
Pages (from-to)426-434
Number of pages9
JournalCirculation Journal
Volume80
Issue number2
DOIs
Publication statusPublished - Jan 25 2016

Keywords

  • Diastolic function
  • Echocardiography
  • Heart failure
  • Hemodynamics
  • Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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