Key result
Azelnidipine increased septal e' velocity in hypertensive patients with and without diabetes, though diabetic patients had persistently lower post-treatment values (6.3 vs 6.9 cm/s; p=0.006).
Why the study?
Does azelnidipine improve left ventricular relaxation in hypertensive patients with normal ejection fraction and impaired left ventricular relaxation, with and without diabetes?
Cohort (n=228)
Yes
Does azelnidipine improve left ventricular relaxation in hypertensive patients with normal ejection fraction and impaired left ventricular relaxation, with and without diabetes?
Absolute Event Rate: 6.3% vs 6.9%
p-value: p=0.006
Azelnidipine improves left ventricular relaxation in hypertensive patients with and without diabetes, though comorbid diabetes independently impairs relaxation beyond blood pressure effects.
May support azelnidipine for LV relaxation in hypertension; diabetes effect and practice change require randomized confirmation.
OBJECTIVES: We previously demonstrated that a calcium channel blocker, azelnidipine, improves left ventricular relaxation in patients with hypertension and diastolic dysfunction in a multicentre, Clinical impact of Azelnidipine on Left VentricuLar diastolic function and OutComes in patients with hypertension (CALVLOC) trial. The objectives of the present subanalysis were to investigate the differences in diastolic function in hypertensive patients with and without diabetes, and the efficacy of azelnidipine on diastolic function among them. DESIGN: Subanalysis of a prospective single-arm multicentre study. PARTICIPANTS: 228 hypertensive patients with normal ejection fraction and impaired left ventricular relaxation (septal e' velocity<8 cm/s on echocardiography) enrolled for CALVLOC trial. They were divided into two groups based on presence or absence of diabetes. INTERVENTIONS: Administration of 16 mg of azelnidipine for 8 months (range 6-10 months). MAIN OUTCOME MEASURES: Septal e' velocity before and at the end of the study. RESULTS: Whereas patients with diabetes (n=53, 23.2%) had lower systolic blood pressure (BP) than patients without diabetes (155±17 vs 161±16 mm Hg, p=0.03), they had lower e' velocity (5.7±1.5 vs 6.1±1.4 cm/s, p=0.04) at baseline. Azelnidipine decreased BP and heart rate, and increased e' velocity similarly in patients with diabetes (5.7±1.5 to 6.3±1.5 cm/s, p=0.0003) and without diabetes (6.1±1.4 to 6.9±1.4 cm/s, p<0.0001). Increase in e' velocity was not influenced by presence of diabetes, and patients with diabetes still had lower e' velocity after treatment (p=0.006). There was a significant correlation between increase in e' velocity and decrease in systolic BP (R=0.25, p=0.0001), which was not influenced by diabetes. CONCLUSIONS: Comorbid diabetes could impair left ventricular relaxation independently in patients with hypertension, which might not be improved solely by BP lowering.
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Iwakura et al. (2014) conducted a cohort in Hypertension with normal ejection fraction and impaired left ventricular relaxation (n=228). Azelnidipine vs. Patients without diabetes was evaluated on Septal e' velocity before and at the end of the study (p=0.006). Azelnidipine increased septal e' velocity in hypertensive patients with and without diabetes, though diabetic patients had persistently lower post-treatment values (6.3 vs 6.9 cm/s; p=0.006).
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