Abstract 5415: Improvement in Diastolic Function With Anti-Hypertensive Therapy: An Analysis From the Combined VALIDD-EXCEED Dataset

Abstract

Background: Hypertension is a risk factor for diastolic dysfunction (DD) and HF with preserved EF. We quantified the relationship between blood pressure (BP) reduction and improvement in DD across a broad range of BP. Methods: Baseline and follow-up BP and mitral annular early relaxation velocity (E′) were analyzed in 337 subjects with mild HTN (SBP 147±16 mmHg) in the VALIDD trial (38 week f/u) and 190 subjects with more severe HTN (SBP 164±16 mmHg) in the EXCEED trial (24 week f/u), all with DD assessed by reduced E′ and no heart failure. Both trials tested different BP reduction strategies for improvement in DD. Results: Baseline SBP was 154.0±18.3 mmHg (IQR 141–165) and baseline E′ was 7.6±1.2 cm/sec (IQR 6.7–8.5). At follow-up, SBP decreased by 16.5±20.8 mmHg, E′ increased by 0.9±1.5 cm/sec, mean achieved SBP was 137.2±15.4 mmHg (IQR 127–145), and mean final E′ was 8.4±1.8 cm/sec (IQR 7.1–9.7). BP reduction was significantly associated with increase in E′, even after adjustment for age, gender, race, smoking, baseline SBP, DBP, HR, trial enrollment, treatment assignment, and baseline E′ (adjusted P=0.0002). Achieved SBP was significantly predictive of final E′, independent of baseline SBP or E′ (adjusted p=0.0005). Conclusions: Among a broad range of hypertensives with diastolic dysfunction, degree of BP reduction is directly related to extent of improvement in diastolic function, with patients achieving SBP < 130 mm Hg demonstrating the greatest overall improvement. These data underscore an important load-dependence of tissue Doppler E′.