From the Guidelines
The best medication for diastolic dysfunction is typically a combination of diuretics, beta-blockers, ACE inhibitors or ARBs, and calcium channel blockers, tailored to the patient's specific symptoms and underlying causes, as evidenced by the 2009 accf/aha expert consensus document 1.
Key Medications
- Diuretics like furosemide (20-80mg daily) or hydrochlorothiazide (12.5-25mg daily) help reduce fluid overload and relieve symptoms of congestion.
- Beta-blockers such as metoprolol (25-200mg daily) or carvedilol (3.125-25mg twice daily) lower heart rate, allowing more time for ventricular filling.
- ACE inhibitors like lisinopril (5-40mg daily) or ARBs such as valsartan (80-320mg daily) reduce afterload and may help prevent cardiac remodeling.
- Calcium channel blockers including amlodipine (5-10mg daily) or verapamil (120-360mg daily) can improve ventricular relaxation.
Treatment Approach
The goal of therapy is to reduce symptoms, improve quality of life, and prevent heart failure progression by optimizing ventricular filling pressures and improving diastolic function. Treatment should address the underlying cause, such as hypertension or coronary artery disease, while lifestyle modifications including sodium restriction, weight management, and regular physical activity are essential complementary approaches. Although the 2001 European Heart Journal guidelines 1 provide some recommendations, the more recent and comprehensive 2009 accf/aha expert consensus document 1 is preferred for guiding treatment decisions.
Underlying Causes and Lifestyle Modifications
It is crucial to identify and manage underlying causes of diastolic dysfunction, such as hypertension, diabetes mellitus, and atherosclerotic disease. Lifestyle modifications, including a low-sodium diet, weight management, and regular physical activity, are also essential in managing the condition and improving quality of life. By prioritizing a patient-centered approach and using the most recent and highest-quality evidence 1, healthcare providers can develop effective treatment plans for individuals with diastolic dysfunction.
From the Research
Medications for Diastolic Dysfunction
The following medications have been found to be beneficial in the treatment of diastolic dysfunction:
- Calcium channel blockers 2, 3, 4, 5, 6
- Beta-blockers 2, 3, 4, 5, 6
- ACE-inhibitors 2, 3, 4, 5, 6
- Angiotensin receptor blockers (ARB) 2, 3, 4, 5, 6
- Nitric oxide donors 2, 6
- Diuretics 3, 4, 5, 6
- Non-dihydropyridine calcium channel blockers 4
- Spirolactones 6
- Bradycardia agents 6
Treatment Approach
The treatment of diastolic dysfunction is often empirical and lacks clear-cut pathophysiologic concepts 2. However, the following approaches have been recommended:
- Treatment of the underlying disease 2, 3, 4, 5, 6
- Control of heart rate 5
- Relief of fluid congestion 5
- Maintenance of the sinus rhythm 4
- Prevention of tachycardia 4
- Venous pressure reduction 4
- Prevention of myocardial ischemia 4
- Prevention of diabetes mellitus 4
Specific Studies
Several studies have investigated the effectiveness of various medications in the treatment of diastolic dysfunction, including:
- The Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) study 3
- The Candesartan in Heart Failure: Assessment in Reduction of Mortality and Morbidity (CHARM-Preserved) trial 3
- The Losartan Intervention For End-point Reduction in Hypertension (LIFE) Study 3
- The Trial Of Preserved Cardiac function heart failure with an Aldosterone anTagonist (TOPCAT) 3