How to improve diastolic dysfunction?

From the Guidelines

To improve diastolic functioning, focus on regular aerobic exercise, a heart-healthy diet, weight management, and blood pressure control through lifestyle modifications and medications. The most recent and highest quality study, 1, suggests that reduction of sodium intake, diets rich in vegetables, fruits, and low-fat dairy products, and Mediterranean diets can improve blood pressure control, which is essential for diastolic functioning. Key interventions include:

• Regular aerobic exercise, such as walking, swimming, or cycling for 30 minutes most days of the week, to enhance cardiac relaxation and filling
• A heart-healthy diet low in sodium (less than 2,300 mg daily) and rich in fruits, vegetables, whole grains, and lean proteins to reduce blood pressure and prevent fluid retention
• Weight management, aiming for a BMI between 18.5-24.9, as excess weight strains the heart
• Blood pressure control, with a target below 130/80 mmHg, through medications like ACE inhibitors (e.g., lisinopril 10-40 mg daily), ARBs (e.g., losartan 25-100 mg daily), or calcium channel blockers (e.g., amlodipine 2.5-10 mg daily) Additional measures, such as limiting alcohol consumption to one drink daily for women and two for men, avoiding tobacco, and practicing stress management techniques like meditation, can further support heart health. These interventions work by reducing afterload, decreasing ventricular stiffness, improving relaxation, and optimizing the pressure gradients needed for proper ventricular filling during diastole, as supported by 1 and 1. It is also important to note that diuretics, such as furosemide (20-80 mg daily) or spironolactone (12.5-50 mg daily), may help reduce fluid overload, as mentioned in 1. Overall, a comprehensive approach to improving diastolic functioning should prioritize lifestyle modifications and evidence-based medications, as recommended by 1 and 1.

From the FDA Drug Label

The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit Lisinopril demonstrated superior reductions of systolic and diastolic compared to hydrochlorothiazide in a population that was 75% Caucasian Lisinopril was approximately equivalent to atenolol and metoprolol in reducing diastolic blood pressure, and had somewhat greater effects on systolic blood pressure.

To improve diastolic functioning, reducing diastolic blood pressure is essential. This can be achieved through the use of certain medications, such as:

• Lisinopril 2, which has been shown to reduce diastolic blood pressure in various studies.
• Spironolactone 3 may also be beneficial in managing conditions that affect diastolic function, such as heart failure. Key points to consider:
• Blood pressure reduction is crucial in reducing cardiovascular risk.
• Modest reductions in blood pressure can provide substantial benefits, especially in patients with severe hypertension.
• The choice of medication should be guided by individual patient characteristics, such as demographics and comorbidities.

From the Research

Improving Diastolic Functioning

To improve diastolic functioning, several strategies can be employed, including:

• Lifestyle interventions such as regular physical exercise, body weight management, and healthy dietary patterns 4
• Stress management and promotion of adequate sleep patterns coupled with circadian entrainment 4
• Exercise training, which has been shown to improve diastolic function in patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) 5, 6
• Combination of endurance and resistance training, which may be beneficial for improving diastolic function 5
• Inspiratory muscle training (IMT), which can improve functional capacity and quality of life in HFpEF patients 5
• Functional electrical stimulation (FES), which can also improve functional capacity and quality of life in HFpEF patients 5

Medications for Improving Diastolic Functioning

Certain medications can also be used to improve diastolic functioning, including:

• ACE inhibitors, which can help to reduce systolic blood pressure and improve diastolic function 7
• Angiotensin-II receptor blockers, which may be preferred first-line agents for treatment of hypertension in diabetes 8
• Thiazide diuretics, which can help to lower systolic blood pressure and improve diastolic function 8, 7
• Calcium-channel blockers, which can help to lower systolic blood pressure and improve diastolic function 7
• Beta-blockers, which may be less effective in improving diastolic function, but can still be used in certain cases 8, 7

Target Blood Pressure Values

Target blood pressure values for improving diastolic functioning include:

• Diastolic blood pressure of less than 80 mm Hg 8
• Systolic blood pressure of 135 mm Hg or less 8