Related Experiment Video
Updated: Mar 28, 2026
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Effect of Diuretic or Calcium-Channel Blocker Plus Angiotensin-Receptor Blocker on Diastolic Function in Hypertensive
Norihisa Toh1, Katsuhisa Ishii, Hajime Kihara
1Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences.
Insights
Combining losartan with hydrochlorothiazide (HCTZ) effectively improves left ventricular (LV) relaxation in hypertensive patients, similar to amlodipine plus an angiotensin-receptor blocker (ARB). This combination therapy is a viable option for managing hypertension and diastolic dysfunction.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Hypertension is a significant risk factor for left ventricular (LV) diastolic dysfunction.
- Antihypertensive medications can potentially improve LV relaxation.
- Investigating combination therapies is crucial for managing complex cardiovascular conditions.
Purpose of the Study:
- To compare the efficacy of two combination antihypertensive regimens in improving LV relaxation.
- To assess the impact of losartan/HCTZ versus CCB/ARB on diastolic function in hypertensive patients.
Main Methods:
- A randomized controlled trial involving hypertensive patients with diastolic dysfunction.
- Patients received either losartan/HCTZ or amlodipine/ARB for 24 weeks.
- The primary endpoint was the change in early diastolic mitral annular velocity (e').
Main Results:
- Both combination therapies led to a decrease in systolic blood pressure.
- Left ventricular (LV) relaxation, measured by e' velocity, improved similarly in both groups.
- The losartan/HCTZ group showed significant reductions in the ratio of early mitral inflow velocity to e' and left atrial volume index.
Conclusions:
- Losartan/HCTZ combination therapy is as effective as amlodipine/ARB in enhancing LV relaxation.
- This finding supports the use of losartan/HCTZ for hypertensive patients with diastolic dysfunction.
Background:
Hypertension increases the risk of left ventricular (LV) diastolic dysfunction, and anti-hypertensive therapy may improve LV relaxation. The aim of this study was to investigate whether combining an angiotensin-receptor blocker (ARB) with either hydrochlorothiazide (HCTZ) or a calcium-channel blocker (CCB) improves LV relaxation in patients with hypertension and diastolic dysfunction.
Methods And Results:
Hypertensive patients who had not achieved their target blood pressure with at least 4 weeks of ARB therapy were randomly assigned to receive either a fixed-dose combination of losartan and HCTZ (losartan/HCTZ; n=110) or a combination of amlodipine and a typical ARB dosage (CCB/ARB; n=121) and followed for 24 weeks. The primary endpoint was change in early diastolic mitral annular velocity (e', cm/s). Systolic blood pressure decreased in both groups after switch to the combination therapies. E' velocity increased both in the losartan/HCTZ (0.52 cm/s) and in the CCB/ARB (0.59 cm/s) groups. The mean (95% CI) treatment difference was -0.02 (-0.37 to 0.34) cm/s, indicating that improvement in LV relaxation was similar between the groups. The ratio of early mitral inflow velocity to e' velocity and left atrial volume index were significantly decreased in the losartan/HCTZ group.
Conclusions:
The combination of losartan and HCTZ is as effective as amlodipine plus ARB in improving LV relaxation in hypertensive patients.
Related Concept Videos
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:18Antihypertensive Drugs: Action of Calcium Channel Blockers
01:16Antihypertensive Drugs: Action of Diuretics
01:22Heart Failure Drugs: Diuretics
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors