J Cardiovasc Imaging.  2020 Jul;28(3):174-182. 10.4250/jcvi.2020.0005.

Addition of Amlodipine or Valsartan for Improvement of Diastolic Dysfunction Associated with Hypertension

Affiliations
  • 1Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
  • 3Division of Cardiology, Inje University Busan Paik Hospital, Busan, Korea
  • 4Division of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea

Abstract

BACKGROUND
Hypertensive patients are at increased risk of diastolic dysfunction. The hypothesis of this study was that addition of amlodipine would be superior to valsartan in improving diastolic dysfunction associated with hypertension.
METHODS
In this randomized trial, we randomly assigned 104 controlled, hypertensive patients with diastolic dysfunction to receive either amlodipine 2.5 mg or valsartan 40 mg, in addition to antihypertensive therapy. The primary end point was the change in the ratio of early mitral inflow velocity to early mitral annular relaxation velocity (E/E′) from baseline to the 6-month follow-up. Secondary end points included changes in systolic blood pressure (SBP), left ventricular (LV) mass index, and left atrial volume index.
RESULTS
SBP decreased significantly from baseline in both treatment groups (p < 0.001). E/E′ decreased significantly from 13.0 ± 2.2 to 12.0 ± 2.7 in the amlodipine arm and from 14.4 ± 4.3 to 12.7 ± 3.7 in the valsartan arm (p < 0.01 in both groups). The change of E/E′ was not significantly different between treatment groups (p = 0.25). There were also no significant between-group differences regarding the changes in SBP, LV mass index, and left atrial volume index. Two patients (3.8%) in the amlodipine group and 1 (16%) in the valsartan group had serious adverse event.
CONCLUSIONS
In this randomized trial involving controlled hypertensive patients, addition of amlodipine or valsartan was associated with an improvement of diastolic dysfunction, but the effects on diastolic dysfunction did not differ significantly between the treatment groups.

Keyword

Amlodipine; Valsartan; Diastolic dysfunction; Hypertension
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