Azilsartan, but not Candesartan Improves Left Ventricular Diastolic Function in Patients with Hypertension and Heart Failure

Diastolic dysfunction is a major cause of heart failure (HF) with a preserved ejection fraction (HFpEF); however, there is no clear strategy for treating diastolic dysfunction. Myocardial and vascular abnormalities may cause HFpEF, which indicates that correcting both abnormalities may specifically improve the severity of diastolic dysfunction. Candesartan primarily affects the myocardium, but azilsartan affects the myocardium and the aortic vasculature. This study was undertaken to test the hypothesis that azilsartan, but not candesartan, improves left ventricular (LV) diastolic dysfunction in patients with hypertension and HFpEF. Among patients with HF in our database, the patients who received azilsartan or candesartan were retrospectively screened. Fifteen patients treated with azilsartan were identified, and sex-matched patients who received candesartan were blindly selected. At baseline, there were no significant differences between the two groups in clinical findings, echocardiographic parameters, and plasma brain natriuretic peptide levels. At 3–6 months, blood pressure decreased to similar levels in both groups. However, the early LV filling velocity/early diastolic velocity (E/e′) ratio decreased in the azilsartan group (13.0 ± 4.2 vs. 10.9 ± 3.2, p = 0.03), but remained unchanged in the candesartan group (12.0 ± 3.6 vs. 12.5 ± 5.0, p = 0.58; for interaction, p = 0.04). Other echocardiographic parameters were unaltered by azilsartan or candesartan. Azilsartan improves diastolic function in HF patients with hypertension, and it may be the preferred option over other angiotensin II receptor blockers in patients with HFpEF.