Age and the effectiveness of anti-hypertensive therapy on improvement in diastolic function
Susan Cheng1, Carolyn Lam, Amil Shah
1aBrigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA bNational University Health System, Singapore cNovartis, East Hanover, New Jersey dState University of New York at Buffalo, Buffalo, New York eUniversity of Alabama, Birmingham, Alabama fUniversity of Michigan, Ann Arbor, Michigan, USA.
Insights
Older adults with hypertension and diastolic dysfunction showed less improvement in diastolic function despite similar blood pressure reductions. Age impacts the effectiveness of antihypertensive therapy on diastolic relaxation.
Area of Science:
- Cardiology
- Gerontology
- Pharmacology
Background:
- Diastolic dysfunction is common in older adults with hypertension and linked to poor outcomes.
- Antihypertensive therapy can improve diastolic function, but age-related effects are unclear.
Purpose of the Study:
- To investigate if age influences the improvement in diastolic function with blood pressure reduction in hypertensive patients with diastolic dysfunction.
Main Methods:
- The study analyzed 189 hypertensive patients (45-93 years) with diastolic dysfunction undergoing echocardiography.
- Patients received intensive or standard antihypertensive therapy for 24 weeks, aiming for specific systolic blood pressure (SBP) goals.
- Linear regression examined the association between age and diastolic function improvement following SBP reduction.
Main Results:
- SBP reduction was similar across age groups, averaging 28 ± 19 mmHg.
- Older patients demonstrated a lower percentage improvement in diastolic relaxation velocity (lateral E' peak velocity) per 10 mmHg SBP reduction compared to younger patients.
- Older age was significantly associated with reduced improvement in diastolic relaxation velocity (β -1.64, P=0.009), while left ventricular mass index changes were not age-dependent.
Conclusions:
- In hypertensive individuals with diastolic dysfunction, older adults experienced diminished diastolic function improvement compared to younger adults, even with comparable SBP reductions.
- Age is a factor influencing the efficacy of antihypertensive treatment on diastolic relaxation in this population.
Objective:
Diastolic dysfunction is associated with adverse outcomes and is highly prevalent among older adults with hypertension. Lowering SBP with antihypertensive therapy has been shown to improve diastolic function, but whether or not age influences this effect is unknown.
Methods:
In the Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction trial, 189 patients (age range 45-93 years) with hypertension and diastolic dysfunction underwent echocardiography before and after 24 weeks of intensive versus standard antihypertensive therapy titrated to a goal SBP below 135 versus below 140 mmHg. We performed linear regression analyses to examine the association between age and improvement in diastolic function achieved with SBP reduction.
Results:
Antihypertensive therapy reduced SBP by 28 ± 19 mmHg overall, and this was not significantly different across age strata. However, percentage improvement in diastolic relaxation velocity (lateral E' peak velocity) for every 10 mmHg reduction in SBP was lower in older compared to younger patients. In analyses adjusting for age stratum, sex, treatment arm, baseline relaxation velocity, and baseline blood pressure, older age was associated with reduced improvement in diastolic relaxation velocity per 10 mmHg of SBP reduction (β -1.64, P = 0.009). In contrast, the degree of change in left ventricular mass index per 10 mmHg reduction in SBP was not influenced by age (P = 0.89).
Conclusions:
In our sample of individuals with hypertension and diastolic dysfunction, older compared to younger adults experienced less improvement in diastolic function in response to similar reductions in SBP.
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