Adding Amlodipine or Valsartan to antihypertensives improves diastolic dysfunction in high BP

Researchers have found that addition of Amlodipine a Calcium channel blocker or valsartan an ARB was associated with a significant improvement of diastolic dysfunction associated with high blood pressure.The new study has been published in the Journal of Cardiovascular Imaging.

Patients with high blood pressure are at increased risk of diastolic dysfunction. The researchers conducted a study to ascertain whether addition of amlodipine would be superior to valsartan in improving diastolic dysfunction associated with high BP or hypertension.

Diastolic dysfunction is a common problem, with many people aged older than 70 years having the condition. In the majority of cases, the condition is not severe enough to lead to diastolic heart failure. Diastolic heart failure is also referred to as heart failure with normal ejection fraction or heart failure with preserved ejection fraction.

The researchers conducted a randomized trial in 104 controlled, patients of high blood pressure (BP) with diastolic dysfunction.

The subjects were randomized to receive either amlodipine 2.5 mg or valsartan 40 mg, in addition to antihypertensive therapy. The primary end point was the change in the ratio of early mitral inflow velocity to early mitral annular relaxation velocity (E/E') from baseline to the 6-month follow-up. Secondary end points included changes in systolic blood pressure (SBP), left ventricular (LV) mass index, and left atrial volume index.

They found that systolic Blood Pressure decreased significantly from baseline in both treatment groups (p < 0.001). E/E' decreased significantly from 13.0 ± 2.2 to 12.0 ± 2.7 in the amlodipine arm and from 14.4 ± 4.3 to 12.7 ± 3.7 in the valsartan arm (p < 0.01 in both groups). The change of E/E' was not significantly different between treatment groups (p = 0.25). There were also no significant between-group differences regarding the changes in SBP, LV mass index, and left atrial volume index. Two patients (3.8%) in the amlodipine group and 1 (16%) in the valsartan group had serious adverse event.

The researchers concluded that in hypertensive patients, addition of amlodipine or valsartan was associated with an improvement of diastolic dysfunction, but the effects on diastolic dysfunction did not differ significantly between the treatment groups. Addition of low-dose Calcium channel blocker or ARB was associated with a significant improvement of diastolic dysfunction.

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