Lowering Blood Pressure Improves Diastolic Dysfunction In Hypertensive Patients

In this study, known as the VALIDD (The VALsartan In Diastolic Dysfunction) trial, conducted at 41 centers in the United States and Canada, researchers aimed to determine whether lowering blood pressure, using two different approaches, could improve diastolic function in patients with hypertension over the age of 45. Nearly 500 patients were screened for diastolic dysfunction using the tissue Doppler assessment of myocardial relaxation velocities, a relatively new method of measuring how fast the heart relaxes. A total of 384 patients with hypertension and diastolic dysfunction were randomized to two blood pressure-lowering arms.

In one arm (n=186), blood pressure was lowered with the renin-angiotensin-aldosterone system (RAAS) inhibitor, valsartan. In the other arm (n=198), blood pressure was lowered without inhibiting the renin-angiotensin aldosterone system. In addition to study medication, patients were given standard blood pressure-lowering drugs, such as diuretics, beta-blockers or calcium channel blockers if needed to treat hypertension, with the aim of achieving a target blood pressure rate of 135/80 mmHg in both treatment groups.

Changes in diastolic dysfunction between baseline and 38 weeks were compared. From baseline to follow-up, researchers observed a greater than 10mmHg reduction in blood pressure in both treatment groups. Diastolic function was improved significantly in both groups, although the improvement observed by inhibiting the RAAS with valsartan and without inhibiting the RAAS was similar.

"There is a tremendous amount of research focusing on systolic function, or how effectively the human heart muscle contracts. But before the heart can expel the blood, the heart must relax in order to fill," said Scott Solomon, M.D., of Brigham and Women's Hospital and Harvard Medical School, and lead author of the study. "Up to 50 percent of all hypertensive patients have evidence of diastolic dysfunction and, although some of these patients will ultimately develop heart failure, there is still no targeted therapy. Our study found that lowering blood pressure can improve diastolic dysfunction even in patients with mild hypertension. These results further support aggressive blood pressure lowering in patients with hypertension, as well as future research looking at ways to improve diastolic function."

Dr. Solomon will present this study, "The Influence of Angiotensin Receptor Blockers and Blood Pressure Lowering on Diastolic Function in Patients With Hypertension and Diastolic Dysfunction: The VALsartan in Diastolic Dysfunction (VALIDD) Trial,"  at American College of Cardiology's 56th Annual Scientific Session.