In hypertension treatment, better diastolic function with amlodipine than atenolol

January 01, 0001

In hypertension treatment, better diastolic function with amlodipine than atenolol

Different antihypertensive therapies may vary in their effect on LV diastolic function. The researchers from England, Australia and Ireland hypothesized that an amlodipine-based regimen would have more favorable effects on left ventricular (LV) diastolic function. The HACVD (Hypertension Associated Cardiovascular Disease) substudy of ASCOT (Anglo- Scandinavian Cardiac Outcomes Trial) collected detailed cardiovascular phenotypic data on a subset of 1,006 participants recruited from 2 centers (St. Mary's Hospital, London, and Beaumont Hospital, Dublin). Conventional and tissue Doppler echocardiography and measurement of plasma B-type natriuretic peptide (BNP) were performed approximately 1 year after randomization to atenolol-based or amlodipine-based antihypertensive treatment to assess LV diastolic function.

On-treatment blood pressure (BP) was similar in both groups: atenolol-based regimen, systolic BP of 137 mm Hg, diastolic BP of 82 mm Hg; amlodipine-based regimen, systolic BP of 136 mm Hg, diastolic BP of 80 mm Hg. Ejection fraction did not differ between groups, but early diastolic mitral annular velocity (E'), a measure of diastolic relaxation, was lower in patients on the atenolol-based regimen: atenolol-based regimen, 7.9; amlodipine-based regimen, 8.8. A measure of left ventricular filling pressure, E/E', and BNP were significantly higher in patients on the atenolol-based regimen. Differences in E', E/E', and BNP remained significant after adjustment for age and sex. Further adjustment for systolic BP, LV mass index, and heart rate had no impact on differences in mean E' or BNP. The difference in E/E' was attenuated.

The researchers concluded: "Patients receiving treatment with an amlodipine-based regimen had better diastolic function than patients treated with the atenolol-based regimen. Treatment-related differences in diastolic function were independent of BP reduction and other factors that are known to affect diastolic function."

Helpful information, but limited to two groups of medications.

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J Am Coll Cardiol 55:1875-1881, 27 April 2010 © 2010 by the American College of Cardiology Foundation
Differential Effects of Antihypertensive Treatment on Left Ventricular Diastolic Function: An ASCOT (Anglo- Scandinavian Cardiac Outcomes Trial) Substudy. Robyn J. Tapp, Andrew Sharp, Alice V. Stanton et al on behalf of the ASCOT Investigators. Correspondence to Dr Robyn Tapp: [email protected]

Category: K. Circulatory. Keywords: effects, antihypertensive, treatment, left ventricular, diastolic, function, tissue Doppler echocardiography, randomized prospective study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 21 May 2010

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