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(Circulation. 2002;105:1071.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Change in Diastolic Left Ventricular Filling After One Year of Antihypertensive Treatment

The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study

Kristian Wachtell, MD, PhD; Jonathan N. Bella, MD; Jens Rokkedal, MD; Vittorio Palmieri, MD; Vasilios Papademetriou, MD; Björn Dahlöf, MD, PhD; Tapio Aalto, MD; Eva Gerdts, MD, PhD; Richard B. Devereux, MD

From Copenhagen County University Hospital, Glostrup, Denmark (K.W., J.R.); Weill Medical College of Cornell University, New York, NY (K.W., J.N.B., V.P., R.B.D.); Veterans Affairs Medical Center, Washington, DC (V.P.); Sahlgrenska University Hospital-Östra, Göteborg, Sweden (B.D.); Helsinki University Central Hospital, Helsinki, Finland (T.A.); and Haukeland Hospital, Bergen, Norway (E.G.).

Correspondence to Dr Kristian Wachtell, Laboratory of Cardiology, Department of Medicine, Copenhagen County University Hospital, Glostrup, DK-2600 Glostrup, Denmark. E-mail kristian{at}wachtell.net

Background— It is well established that hypertensive patients with left ventricular (LV) hypertrophy have impaired diastolic filling. However, the impact of antihypertensive treatment and LV mass reduction on LV diastolic filling remains unclear.

Methods and Results— Echocardiograms were recorded in 728 hypertensive patients with ECG-verified LV hypertrophy (Cornell voltage-duration or Sokolow-Lyon) at baseline and after 1 year of blinded treatment with either losartan or atenolol-based regimen. Systolic and diastolic blood pressures (BP) were reduced on average 23/11 mm Hg; isovolumic relaxation time and E/A ratio became more normal, and LV inflow deceleration time prolonged (all P<0.001). Directionally opposite changes in isovolumic relaxation time (IVRT) and deceleration time indicate improvement in active LV relaxation and passive chamber stiffness during early diastole. Prevalences of normal LV filling increased, abnormal relaxation and pseudonormalization decreased, and restrictive filling pattern remained unchanged (P<0.05). Patients with reduction in LV mass had smaller left atrial diameter, shortened IVRT, increased E/A ratio, and prolonged LV inflow deceleration time (all P<0.001). Patients without LV mass reduction had no change in diastolic filling parameters (P=NS). IVRT shortening was independently associated with reduction in LV mass. Increase in E/A ratio was independently associated with reduction in diastolic BP, and increase in the deceleration time was independently associated with reduced end-systolic relative wall thickness.

Conclusions— Antihypertensive therapy resulting in LV mass or relative wall thickness regression is associated with significant improvement of diastolic filling parameters related to active relaxation and passive chamber stiffness compared with patients without regression, independent of BP reduction; however, abnormalities of diastolic LV filling remain common.

Key Words: diastole • ventricles • hypertension • blood pressure

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