Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial

Scott D. Solomon; Rajesh Janardhanan; Anil Verma; Mikhail Bourgoun; William L. Daley; Das Purkayastha; Yves Lacourcière; Stephen E. Hippler; Harold Fields; Tasneem Z. Naqvi; Sharon L. Mulvagh; J. Malcolm O. Arnold; James D. Thomas; Michael R. Zile; Gerard P. Aurigemma

doi:10.1016/S0140-6736(07)60980-5

Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial

Scott D. Solomon, Rajesh Janardhanan, Anil Verma, Mikhail Bourgoun, William L. Daley, Das Purkayastha, Yves Lacourcière, Stephen E. Hippler, Harold Fields, Tasneem Z. Naqvi, Sharon L. Mulvagh, J. Malcolm O. Arnold, James D. Thomas, Michael R. Zile, Gerard P. Aurigemma

Research output: Contribution to journal › Article › peer-review

273 Scopus citations

Abstract

Background: Diastolic dysfunction might represent an important pathophysiological intermediate between hypertension and heart failure. Our aim was to determine whether inhibitors of the renin-angiotensin-aldosterone system, which can reduce ventricular hypertrophy and myocardial fibrosis, can improve diastolic function to a greater extent than can other antihypertensive agents. Methods: Patients with hypertension and evidence of diastolic dysfunction were randomly assigned to receive either the angiotensin receptor blocker valsartan (titrated to 320 mg once daily) or matched placebo. Patients in both groups also received concomitant antihypertensive agents that did not inhibit the renin-angiotensin system to reach targets of under 135 mm Hg systolic blood pressure and under 80 mm Hg diastolic blood pressure. The primary endpoint was change in diastolic relaxation velocity between baseline and 38 weeks as determined by tissue doppler imaging. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170924. Findings: 186 patients were randomly assigned to receive valsartan; 198 were randomly assigned to receive placebo. 43 patients were lost to follow-up or discontinued the assigned intervention. Over 38 weeks, there was a 12·8 (SD 17·2)/7·1 (9·9) mm Hg reduction in blood pressure in the valsartan group and a 9·7 (17·0)/5·5 (10·2) mm Hg reduction in the placebo group. The difference in blood pressure reduction between the two groups was not significant. Diastolic relaxation velocity increased by 0·60 (SD 1·4) cm/s from baseline in the valsartan group (p<0·0001) and 0·44 (1·4) cm/s from baseline in the placebo group (p<0·0001) by week 38. However, there was no significant difference in the change in diastolic relaxation velocity between the groups (p=0·29). Interpretation: Lowering blood pressure improves diastolic function irrespective of the type of antihypertensive agent used.

Original language	English (US)
Pages (from-to)	2079-2087
Number of pages	9
Journal	Lancet
Volume	369
Issue number	9579
DOIs	https://doi.org/10.1016/S0140-6736(07)60980-5
State	Published - Jun 23 2007

ASJC Scopus subject areas

General Medicine

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10.1016/S0140-6736(07)60980-5

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Solomon, S. D., Janardhanan, R., Verma, A., Bourgoun, M., Daley, W. L., Purkayastha, D., Lacourcière, Y., Hippler, S. E., Fields, H., Naqvi, T. Z., Mulvagh, S. L., Arnold, J. M. O., Thomas, J. D., Zile, M. R., & Aurigemma, G. P. (2007). Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial. Lancet, 369(9579), 2079-2087. https://doi.org/10.1016/S0140-6736(07)60980-5

Solomon, SD, Janardhanan, R, Verma, A, Bourgoun, M, Daley, WL, Purkayastha, D, Lacourcière, Y, Hippler, SE, Fields, H, Naqvi, TZ, Mulvagh, SL, Arnold, JMO, Thomas, JD, Zile, MR & Aurigemma, GP 2007, 'Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial', Lancet, vol. 369, no. 9579, pp. 2079-2087. https://doi.org/10.1016/S0140-6736(07)60980-5

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title = "Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial",

abstract = "Background: Diastolic dysfunction might represent an important pathophysiological intermediate between hypertension and heart failure. Our aim was to determine whether inhibitors of the renin-angiotensin-aldosterone system, which can reduce ventricular hypertrophy and myocardial fibrosis, can improve diastolic function to a greater extent than can other antihypertensive agents. Methods: Patients with hypertension and evidence of diastolic dysfunction were randomly assigned to receive either the angiotensin receptor blocker valsartan (titrated to 320 mg once daily) or matched placebo. Patients in both groups also received concomitant antihypertensive agents that did not inhibit the renin-angiotensin system to reach targets of under 135 mm Hg systolic blood pressure and under 80 mm Hg diastolic blood pressure. The primary endpoint was change in diastolic relaxation velocity between baseline and 38 weeks as determined by tissue doppler imaging. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170924. Findings: 186 patients were randomly assigned to receive valsartan; 198 were randomly assigned to receive placebo. 43 patients were lost to follow-up or discontinued the assigned intervention. Over 38 weeks, there was a 12·8 (SD 17·2)/7·1 (9·9) mm Hg reduction in blood pressure in the valsartan group and a 9·7 (17·0)/5·5 (10·2) mm Hg reduction in the placebo group. The difference in blood pressure reduction between the two groups was not significant. Diastolic relaxation velocity increased by 0·60 (SD 1·4) cm/s from baseline in the valsartan group (p<0·0001) and 0·44 (1·4) cm/s from baseline in the placebo group (p<0·0001) by week 38. However, there was no significant difference in the change in diastolic relaxation velocity between the groups (p=0·29). Interpretation: Lowering blood pressure improves diastolic function irrespective of the type of antihypertensive agent used.",

author = "Solomon, {Scott D.} and Rajesh Janardhanan and Anil Verma and Mikhail Bourgoun and Daley, {William L.} and Das Purkayastha and Yves Lacourci{\`e}re and Hippler, {Stephen E.} and Harold Fields and Naqvi, {Tasneem Z.} and Mulvagh, {Sharon L.} and Arnold, {J. Malcolm O.} and Thomas, {James D.} and Zile, {Michael R.} and Aurigemma, {Gerard P.}",

note = "Funding Information: We greatly appreciate the expert assistance of Jose Rivero, Faranak Farrohi, Rachel Anderson, Latonya Collins, Eunice Artis, Rita Samuel, and Susan Ritter in the conduct of this trial. This trial was funded by Novartis Pharmaceuticals.",

year = "2007",

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doi = "10.1016/S0140-6736(07)60980-5",

language = "English (US)",

volume = "369",

pages = "2079--2087",

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TY - JOUR

T1 - Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction

T2 - a randomised trial

AU - Solomon, Scott D.

AU - Janardhanan, Rajesh

AU - Verma, Anil

AU - Bourgoun, Mikhail

AU - Daley, William L.

AU - Purkayastha, Das

AU - Lacourcière, Yves

AU - Hippler, Stephen E.

AU - Fields, Harold

AU - Naqvi, Tasneem Z.

AU - Mulvagh, Sharon L.

AU - Arnold, J. Malcolm O.

AU - Thomas, James D.

AU - Zile, Michael R.

AU - Aurigemma, Gerard P.

N1 - Funding Information: We greatly appreciate the expert assistance of Jose Rivero, Faranak Farrohi, Rachel Anderson, Latonya Collins, Eunice Artis, Rita Samuel, and Susan Ritter in the conduct of this trial. This trial was funded by Novartis Pharmaceuticals.

PY - 2007/6/23

Y1 - 2007/6/23

N2 - Background: Diastolic dysfunction might represent an important pathophysiological intermediate between hypertension and heart failure. Our aim was to determine whether inhibitors of the renin-angiotensin-aldosterone system, which can reduce ventricular hypertrophy and myocardial fibrosis, can improve diastolic function to a greater extent than can other antihypertensive agents. Methods: Patients with hypertension and evidence of diastolic dysfunction were randomly assigned to receive either the angiotensin receptor blocker valsartan (titrated to 320 mg once daily) or matched placebo. Patients in both groups also received concomitant antihypertensive agents that did not inhibit the renin-angiotensin system to reach targets of under 135 mm Hg systolic blood pressure and under 80 mm Hg diastolic blood pressure. The primary endpoint was change in diastolic relaxation velocity between baseline and 38 weeks as determined by tissue doppler imaging. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170924. Findings: 186 patients were randomly assigned to receive valsartan; 198 were randomly assigned to receive placebo. 43 patients were lost to follow-up or discontinued the assigned intervention. Over 38 weeks, there was a 12·8 (SD 17·2)/7·1 (9·9) mm Hg reduction in blood pressure in the valsartan group and a 9·7 (17·0)/5·5 (10·2) mm Hg reduction in the placebo group. The difference in blood pressure reduction between the two groups was not significant. Diastolic relaxation velocity increased by 0·60 (SD 1·4) cm/s from baseline in the valsartan group (p<0·0001) and 0·44 (1·4) cm/s from baseline in the placebo group (p<0·0001) by week 38. However, there was no significant difference in the change in diastolic relaxation velocity between the groups (p=0·29). Interpretation: Lowering blood pressure improves diastolic function irrespective of the type of antihypertensive agent used.

AB - Background: Diastolic dysfunction might represent an important pathophysiological intermediate between hypertension and heart failure. Our aim was to determine whether inhibitors of the renin-angiotensin-aldosterone system, which can reduce ventricular hypertrophy and myocardial fibrosis, can improve diastolic function to a greater extent than can other antihypertensive agents. Methods: Patients with hypertension and evidence of diastolic dysfunction were randomly assigned to receive either the angiotensin receptor blocker valsartan (titrated to 320 mg once daily) or matched placebo. Patients in both groups also received concomitant antihypertensive agents that did not inhibit the renin-angiotensin system to reach targets of under 135 mm Hg systolic blood pressure and under 80 mm Hg diastolic blood pressure. The primary endpoint was change in diastolic relaxation velocity between baseline and 38 weeks as determined by tissue doppler imaging. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170924. Findings: 186 patients were randomly assigned to receive valsartan; 198 were randomly assigned to receive placebo. 43 patients were lost to follow-up or discontinued the assigned intervention. Over 38 weeks, there was a 12·8 (SD 17·2)/7·1 (9·9) mm Hg reduction in blood pressure in the valsartan group and a 9·7 (17·0)/5·5 (10·2) mm Hg reduction in the placebo group. The difference in blood pressure reduction between the two groups was not significant. Diastolic relaxation velocity increased by 0·60 (SD 1·4) cm/s from baseline in the valsartan group (p<0·0001) and 0·44 (1·4) cm/s from baseline in the placebo group (p<0·0001) by week 38. However, there was no significant difference in the change in diastolic relaxation velocity between the groups (p=0·29). Interpretation: Lowering blood pressure improves diastolic function irrespective of the type of antihypertensive agent used.

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Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial

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