What are the implications of Grade 1 Diastolic (diastolic) dysfunction?

From the Guidelines

Grade 1 diastolic dysfunction should be managed by controlling underlying conditions like hypertension, diabetes, and coronary artery disease, with medications such as ACE inhibitors, ARBs, or beta-blockers, and lifestyle modifications including sodium restriction, regular aerobic exercise, weight management, and limiting alcohol consumption. The condition is characterized by decreased early filling (E wave) and increased atrial filling (A wave) on echocardiography, with an E/A ratio less than 0.8 1. Management typically includes:

• Controlling underlying conditions like hypertension, diabetes, and coronary artery disease
• Medications such as ACE inhibitors (like lisinopril 10-40 mg daily), ARBs (such as losartan 25-100 mg daily), or beta-blockers (metoprolol 25-200 mg daily) to reduce blood pressure and improve ventricular relaxation
• Lifestyle modifications including:
  • Sodium restriction to less than 2,300 mg daily
  • Regular aerobic exercise (30 minutes most days)
  • Weight management
  • Limiting alcohol consumption
• Diuretics may be used if fluid retention occurs, typically starting with hydrochlorothiazide 12.5-25 mg daily Regular follow-up with echocardiography every 1-2 years is recommended to monitor progression 1. Grade 1 diastolic dysfunction often has minimal symptoms but can progress to more severe forms if underlying conditions aren't adequately controlled, potentially leading to heart failure with preserved ejection fraction 1. It is essential to note that the management of grade 1 diastolic dysfunction is primarily focused on controlling underlying conditions and improving symptoms, rather than reversing the condition itself 1.

From the Research

Grade 1 Diastolic Dysfunction

• Diastolic dysfunction is present in half of patients with hypertension and has been shown to be associated with increased cardiovascular morbidity and mortality, as well as the development of heart failure 2.
• Angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been shown to be effective in improvement of measures of diastolic function and are recommended as first-line agents in the control of hypertension in patients with diastolic heart failure 2.
• Beta-blockers, calcium channel blockers, and diuretics have also shown some efficacy in improved indices of diastolic filling 2.

Treatment of Grade 1 Diastolic Dysfunction

• The optimal diastolic blood pressure range for patients with treated systolic blood pressure less than 130 mm Hg is between 70 and 80 mm Hg 3.
• Lowering diastolic blood pressure to less than 60 mm Hg is associated with increased risk of cardiovascular events in patients with high cardiovascular risk and an treated systolic blood pressure less than 130 mm Hg 3.
• Calcium channel blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors are effective in combination with diuretics or beta-blockers for treating hypertension 4.
• Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering systolic blood pressure 5.

Management of Grade 1 Diastolic Dysfunction

• Antihypertensive drug treatment should be initiated when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk 6.
• The goal of treatment is to achieve systolic blood pressure levels below 140 mmHg in all hypertensive patients, including the elderly, and values below 130 mmHg in patients having diabetes and high/very-high-risk patients 6.
• Combination therapy will usually be required to achieve goal blood pressure in elderly people with essential hypertension 5.