Optimal Treatment of Hypertension with Diastolic Heart Failure

Approximately 5 million people in the United States have heart failure. Epidemiologic studies have demonstrated that at least one half of patients who have clinically overt heart failure have diastolic heart failure (DHF), or heart failure with preserved ejection fraction. DHF is characterized by concentric remodeling with normal left ventricular end-diastolic volume, abnormalities of active relaxation, and increased passive ventricular stiffness. Diuretics are an essential component of therapy for most patients who have DHF, and treatment of hypertension is a cornerstone of therapy designed to prevent or to treat DHF. Several antihypertensive agents have been shown to effectively reduce wave reflection, including angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium antagonists, and nitrates. Lifestyle changes may also be helpful.