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Age and the effectiveness of anti-hypertensive therapy on improvement in diastolic function

Cheng, Susana; Lam, Carolynb; Shah, Amila; Claggett, Briana; Desai, Akshaya; Hilkert, Robert J.c; Izzo, Josephd; Oparil, Suzannee; Pitt, Bertramf; Solomon, Scott D.a

doi: 10.1097/HJH.0b013e32836586da
ORIGINAL PAPERS: Therapeutic aspects

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.

aBrigham 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

Correspondence to Susan Cheng, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Tel: +1 857 307 1960; fax: +1 617 812 0425; e-mail: scheng3@partners.org

Abbreviations: E/a, E-wave to a-wave ratio; E′, peak lateral E′ velocity; LVEF, left ventricular ejection fraction; IVRT, isovolumic relaxation time; LAVI, left atrial volume indexed to body surface area; LVMI, left ventricular mass indexed to body surface area; LVWT, Left ventricular wall thickness; RWT, relative wall thickness

Received 28 March, 2013

Revised 25 June, 2013

Accepted 1 August, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins