From the Guidelines
To mitigate grade 2 diastolic dysfunction, controlling systolic and diastolic hypertension is crucial, and physicians should follow published guidelines for hypertension management, as recommended by the American College of Cardiology/American Heart Association 1. The management of grade 2 diastolic dysfunction involves a multifaceted approach that includes lifestyle modifications and pharmacological interventions.
- Controlling blood pressure is essential, and the use of diuretics to control pulmonary congestion and peripheral edema is recommended 1.
- Additionally, coronary revascularization may be considered in patients with coronary artery disease who have symptomatic or demonstrable myocardial ischemia 1.
- Lifestyle changes, such as maintaining a low-sodium diet, engaging in regular moderate exercise, achieving weight loss if overweight, and strictly controlling diabetes and cholesterol, are also crucial in managing diastolic dysfunction.
- The American Heart Association recommends dietary approaches to prevent and treat hypertension, including weight loss, reduced salt intake, and increased potassium intake 1.
- Regular follow-up with echocardiography every 1-2 years is recommended to monitor progression, with more frequent visits if symptoms worsen.
- The goal of treatment is to reduce left ventricular filling pressures and prevent progression to more severe diastolic dysfunction, which can lead to heart failure with preserved ejection fraction.
- It is also important to note that the use of beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, or calcium antagonists may be effective in minimizing symptoms of heart failure, although the evidence is not as strong 1.
From the FDA Drug Label
In two placebo controlled, 12-week clinical studies compared the addition of lisinopril up to 20 mg daily to digitalis and diuretics alone. The combination of lisinopril, digitalis and diuretics reduced the following signs and symptoms of heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention In one of the studies, the combination of lisinopril, digitalis and diuretics reduced orthopnea, presence of third heart sound and the number of patients classified as NYHA Class III and IV; and improved exercise tolerance.
The answer to mitigating grade 2 diastolic dysfunction is to use lisinopril in combination with digitalis and diuretics. This combination has been shown to reduce signs and symptoms of heart failure, including those associated with diastolic dysfunction, such as orthopnea and presence of third heart sound, and improve exercise tolerance 2.
- Key points:
- Lisinopril is an ACE inhibitor that has been shown to be effective in reducing blood pressure and improving symptoms of heart failure.
- The combination of lisinopril, digitalis, and diuretics has been shown to be effective in reducing signs and symptoms of heart failure, including those associated with diastolic dysfunction.
- This combination may be considered as a treatment option for patients with grade 2 diastolic dysfunction.
From the Research
Mitigating Grade 2 Diastolic Dysfunction
To mitigate grade 2 diastolic dysfunction, several strategies can be employed, including:
- Lifestyle modifications, such as weight loss, healthy dietary patterns, physical activity, and moderation or elimination of alcohol consumption 3
- Pharmacologic interventions, including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, and diuretics 4, 3
- Dietary approaches, such as the Dietary Approaches to Stop Hypertension (DASH) diet, which has been shown to lower blood pressure, body weight, and cholesterol levels 5
Lifestyle Modifications
Lifestyle modifications are an essential component of mitigating grade 2 diastolic dysfunction, and include:
- Weight loss, which can help reduce blood pressure and improve diastolic function 6, 3
- Healthy dietary patterns, such as the DASH diet, which emphasizes low sodium and high potassium intake, as well as physical activity and limited alcohol consumption 3, 5
- Exercise training, which can enhance diastolic function and exercise capacity in patients with diastolic dysfunction 7
Pharmacologic Interventions
Pharmacologic interventions can also play a crucial role in mitigating grade 2 diastolic dysfunction, and include:
- Angiotensin converting enzyme inhibitors and angiotensin receptor blockers, which have been shown to improve measures of diastolic function and are recommended as first-line agents in the control of hypertension in patients with diastolic heart failure 4
- Beta-blockers, calcium channel blockers, and diuretics, which have also shown some efficacy in improving indices of diastolic filling 4
- Thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers, which are recommended as first-line therapies for hypertension 3