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High Blood Pressure

Information on diastolic dysfunction

07/02/2007

Question:

I HAVE BEEN DIAGNOSED WITH DIASTOLIC DYSFUNCTION DUE TO HYPERTENSION. WILL THE THICKENING OF THE LEFT VENTRICLE STOP-SLOW DOWN-OR CONTINUE WITH THE CORRECT MEDICATION?

Answer:

Diastolic dysfunction is usually caused by high blood pressure.  The increased pressure causes the heart muscle to increase in size.  While this allows the heart to produce more pressure, it also makes the heart muscle less elastic.  During diastole, when the ventricles relax and fill with blood, this loss of elasticity interferes with the easy filling of the ventricle.  The lack of adequate filling can cause heart failure.

Diastolic dysfunction is often less severe than systolic dysfunction (caused by weakness of the heart muscle), but diastolic dysfunction, if untreated can become systolic dysfunction over time.

There are no guidelines as to the best treatment of diastolic dysfunction.  However, a few principles are generally accepted:

-Treat hypertension aggressively, preferably to a systolic pressure (the upper number) of 120 mmHg or less

-Keep the heart rate around 60.  Beta blockers and diltiazem or verapamil are good drugs to slow down a fast heart rate.

-Use drugs that block the renin-angiotensin system (ACE inhibitors or angiotensin receptor blockers.  Angiotensin receptor blockers have the best data so far.

-Although not completely proven, there are good data that left ventricular hypertrophy can be reversed, and that diastolic dysfunction can be improved with time.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati