Effects of antihypertensive therapy on diastolic dysfunction in left ventricular hypertrophy

In systemic hypertension, a certain degree of impairment of left ventricular diastolic function is often detectable, and is the consequence of two factors: elevated afterload and left ventricular hypertrophy. The goal of improving diastolic dysfunction can thus be achieved by lowering blood pressure and by inducing a regression in left ventricular hypertrophy. A reduction in blood pressure by intravenous administration of verapamil has proved capable of enhancing left ventricular filling properties in patients with hypertension. This finding has not been corroborated, however, in midterm protocols using an array of drugs (beta-blockers, dihydropyridines, diltiazem, and diuretics). Reduction in left ventricular mass can be achieved by several categories of drugs, and it has been shown that a decrease in mass is accompanied by an improvement in the early diastolic filling pattern. The kind of drug used to accomplish mass reduction seems to be irrelevant as far as the improvement in diastolic function is concerned. The pattern of left ventricular hypertrophy, however, might play a role in influencing the outcome on diastolic mechanics of left ventricular mass decrease.