News Release

Blood pressure drugs relax heart, reduce heart failure risk

Peer-Reviewed Publication

American Heart Association

DALLAS, Feb. 11 – People who take medications to lower blood pressure may also be improving their heart’s pumping action, thus reducing their risk of congestive heart failure, according to research in today’s rapid access issue of Circulation: Journal of the American Heart Association.

“The new findings suggest that a year or more of treatment with antihypertensive drugs can improve the way the heart’s pumping chamber fills with blood, and that improvement may prevent the development of congestive heart failure,” says Kristian Wachtell, M.D., Ph.D., lead author of the study and an assistant professor of medicine at Copenhagen County University Hospital, Glostrup, Denmark.

This study marks the first time that researchers can link changes in the geometry of the left ventricle, the heart’s main pumping chamber, to improved diastolic function. “That’s important, because diastolic dysfunction is the cause of congestive heart failure in about 40 percent of older people,” says Wachtell.

Diastolic ventricular dysfunction means that the left ventricle fails to properly fill during the relaxed or “diastolic” phase of the heart’s pumping action. The thickened left ventricle is stiff, making it unable to fully relax. The result is that the left side of the heart pumps too little blood while the right side pumps normally, filling the lungs with blood, which ultimately can result in pulmonary edema and death.

High blood pressure, or hypertension, is a recognized risk factor for diastolic ventricular dysfunction. High blood pressure is defined in an adult as a systolic pressure (top number in a blood pressure reading) of 140 millimeters of mercury (mmHg) or higher and/or a diastolic pressure (bottom number) of 90 mmHg or higher.

Wachtell’s group used echocardiograms to measure heart wall thickness and ventricular filling in 728 hypertensive patients with enlarged hearts. They were participating in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study. Participants were randomized to receive blood pressure reducing drugs: either losartan, which is an angiotensin II receptor blocker, or atenolol, a beta-blocker. After a year, participants were examined again with an echocardiogram.

Blood pressure reductions averaged 23 mmHg systolic and 11 mmHg diastolic after a year of treatment. Heart mass was reduced by about 10 percent on average, which led to improved blood flow into the left ventricle. At baseline, 15 percent of patients had normal left ventricular filling. After one year of treatment, the prevalence of normal filling was about 26 percent.

In addition, there was improvement in the heart’s ability to relax and a reduction in stiffness, which was significant among patients who had a reduction or regression in left ventricular mass, notes Wachtell.

For the patients who showed a reduction in left ventricular mass, relaxation time decreased from 116 milliseconds (ms) at baseline to 104 ms after one year of treatment.

The LIFE study is ongoing, and the investigators don’t know yet which of the two antihypertensive drugs each patient is taking. For that reason, they are unable to predict if one drug is more effective than the other. The American Heart Association estimates that 4.8 million Americans have congestive heart failure, while as many as 50 million Americans have high blood pressure.

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Co-authors are Jonathan N. Bella, M.D.; Jens Rokkedal, M.D.; Vittorio Palmieri, M.D.; Vasilios Papademetriou, M.D.; Björn Dahlöf, M.D., Ph.D.; Tapio Aalto, M.D.; Eva Gerdts, M.D., Ph.D.; and Richard B. Devereux, M.D.

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