Management of left ventricular diastolic heart failure: is it only blood pressure control?

Abstract

Diastolic heart failure (DHF) is the most common form of heart failure (HF) seen by clinicians today in practice. With the increasing prevalence of DHF, the need for greater spectrum of proven therapies in this condition is clear. There are few data available to guide the therapy of these patients, and no treatment has been shown to improve survival in DHF. The results of the Hong Kong DHF trial, the first comparative study between an angiotensin converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB), again did not provide evidence for a superior effect of ACE inhibitors or ARBs in patients with diastolic heart failure. Traditionally, treatments for congestive HF with decreased ejection fraction have been used to treat DHS, without much proof of benefit. The high mortality and morbidity of these patients underscore the urgent need to find ways to improve outcomes for these patients. Consequently, the care of these patients should be redirected toward screening and treatment of crucial comorbidities such as hypertension, coronary artery disease, atrial fibrillation, obesity, diabetes, and chronic kidney disease.