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Adding thiazide to a renin-angiotensin blocker improves left ventricular relaxation and improves heart failure in

Hiroshi Ito1, Katsuhisa Ishii, Hajime Kihara

  • 1Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Okayama, Japan. itomd@md.okayama-u.ac.jp

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|October 21, 2011
PubMed

Insights

Switching hypertension patients with diastolic dysfunction from ACE inhibitors or ARBs to losartan/HCTZ improved heart function and reduced inflammation. This treatment change offers a promising strategy for managing hypertensive heart disease.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Hypertension significantly increases the risk of diastolic dysfunction.
  • Established treatments like ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) have shown limited efficacy in improving clinical outcomes for patients with diastolic dysfunction.
  • Diastolic dysfunction, a key component of heart failure with preserved ejection fraction (HFpEF), requires effective therapeutic strategies.

Purpose of the Study:

  • To evaluate the impact of switching from ACEi or ARB to a combination of losartan and hydrochlorothiazide (HCTZ) on left ventricular (LV) relaxation and preload in hypertensive patients with diastolic dysfunction.
  • To assess the efficacy of this drug regimen change in improving cardiac function markers and reducing systemic inflammation.
  • To determine the safety and tolerability of the losartan/HCTZ combination in this patient population.

Main Methods:

  • A prospective study involving 371 hypertensive patients diagnosed with diastolic dysfunction who were inadequately controlled on ACEi or ARB.
  • Patients were switched from their current ACEi or ARB therapy to a combination of losartan/HCTZ.
  • Primary endpoints included changes in septal mitral annular velocity during diastole (e') and the ratio of mitral inflow velocity to e' velocity (E/e' ratio) over a 24-week follow-up period.

Main Results:

  • Significant reductions in both systolic (22 mm Hg) and diastolic (11 mm Hg) blood pressure were observed post-switch.
  • The study demonstrated a significant increase in e' velocity and a significant decrease in the E/e' ratio, indicating improved LV relaxation.
  • Key markers of heart failure and systemic inflammation, including brain natriuretic peptide and high-sensitivity C-reactive protein, were significantly reduced, with minimal changes in glucose, insulin resistance, uric acid, or electrolytes.

Conclusions:

  • Switching hypertensive patients with diastolic dysfunction from ACEi or ARB to losartan/HCTZ effectively reduces blood pressure and improves left ventricular diastolic function.
  • This therapeutic adjustment leads to a reduction in heart failure status and systemic inflammation.
  • The losartan/HCTZ combination represents a safe and effective alternative for managing hypertension in patients with diastolic dysfunction, offering significant clinical benefits with few adverse effects.

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