Treatment of Isolated Left Ventricular Diastolic Dysfunction in Hypertension

Abstract

Arterial hypertension is a major risk factor for congestive heart failure. Left ventricular (LV) hypertrophy is often associated with arterial hypertension and characterizes subjects with a particularly elevated risk of untoward cardiovascular events, including heart failure.1 LV hypertrophy is, in turn, associated with impaired LV myocardial contractility and LV diastolic dysfunction. LV hypertrophy, impaired LV myocardial contractility, and LV diastolic dysfunction predict heart failure in population-based studies.2,3 Subjects with heart failure but with normal LV ejection fraction, that is, with diastolic heart failure, exhibit abnormal LV diastolic function.4 However, Doppler parameters of LV diastolic function may be abnormal in the absence of overt heart failure. Such a condition, called “isolated LV diastolic dysfunction,” bears independent prognostic significance in population-based and clinical studies.2,3,5 Thus, regression of isolated LV diastolic dysfunction may be considered an important therapeutic target in hypertension. In the general adult population without congestive heart failure, ≈30% may show LV diastolic dysfunction of any degree.6 In high-risk subgroups (patients >65 years of age, those with hypertension, and those with LV hypertrophy), the prevalence of isolated LV diastolic dysfunction rises to 60–80%.7 On the other hand, LV diastolic dysfunction may be found in ≈26% of hypertensive subjects without LV hypertrophy and with normal myocardial contractility.8 LV hypertrophy regression, proven to be protective in hypertension,9 is a major determinant of LV diastolic dysfunction regression in hypertensive subjects.7 However, it remains to be explored whether isolated LV diastolic dysfunction …