From the Guidelines
Diastolic dysfunction is typically treated with beta blockers such as metoprolol succinate (25-100mg daily) or carvedilol (6.25-25mg twice daily) to reduce heart rate and improve diastolic function 1.
Key Medications
- Beta blockers: metoprolol succinate (25-100mg daily) or carvedilol (6.25-25mg twice daily) to reduce heart rate and improve diastolic function 1
- Angiotensin-converting enzyme inhibitors (ACE inhibitors): lisinopril (5-20mg daily) to improve relaxation and cardiac distensibility directly, and reduce hypertension 1
- Verapamil-type calcium antagonists: may be used to lower heart rate and increase the diastolic period 1
- Diuretics: may be necessary when episodes with fluid overload are present, but should be used cautiously to avoid lowering preload excessively and reducing stroke volume and cardiac output 1
Treatment Approach
The management of patients with diastolic dysfunction is frequently determined by a set of therapeutic principles, including control of blood pressure, control of tachycardia, reduction in central blood volume, and alleviation of myocardial ischemia 1.
Important Considerations
- Treatment duration is typically long-term, and dose titration is individualized based on patient response and tolerance
- The diagnosis of diastolic HF is generally based on the finding of typical symptoms and signs of HF in a patient who is shown to have a normal left ventricular ejection fraction and no valvular abnormalities on echocardiography 1
From the FDA Drug Label
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. In this study, lisinopril was given either as tablets or in a suspension for those children and infants who were unable to swallow tablets or who required a lower dose than is available in tablet form 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
Lisinopril is used for diastolic dysfunction as part of heart failure treatment, by reducing diastolic blood pressure and alleviating symptoms of heart failure, such as edema and paroxysmal nocturnal dyspnea 2.
From the Research
Medications for Diastolic Dysfunction
The following medications are used to treat diastolic dysfunction:
- Calcium channel blockers 3
- Beta-blockers 3, 4, 5
- ACE-inhibitors 3, 4, 6, 5, 7
- AT2-blockers 3
- Nitric oxide donors 3
- Angiotensin receptor blockers 4, 6, 5
- Diuretics 4, 5, 7
- Non-dihydropyridine calcium channel blockers 4
- Spirolactones 7
- Bradycardia agents 7
Treatment Approach
Treatment of diastolic dysfunction is often empirical and lacks clear-cut pathophysiologic concepts 3. The management of diastolic heart failure should include: