Summary
In a first randomized study of its kind, diastolic function, as assessed by noninvasive Doppler technology, was shown to be improved by lowering blood-pressure. The Valsartan in Diastolic Dysfunction [VALIDD] trial evaluated 482 patients from 41 North American sites with stage 1 or 2 essential hypertension using the relatively new method of Doppler tissue imaging to determine myocardial relaxation velocities.
- Hypertensive Disease Clinical Trials
In a first randomized study of its kind, diastolic function, as assessed by noninvasive Doppler technology, was shown to be improved by lowering blood-pressure. The Valsartan in Diastolic Dysfunction (VALIDD) trial evaluated 482 patients from 41 North American sites with stage 1 or 2 essential hypertension using the relatively new method of Doppler tissue imaging to determine myocardial relaxation velocities. Investigators identified 384 patients with evidence of diastolic dysfunction based on low lateral mitral annular relaxation velocities and randomly assigned them to valsartan 320 mg/day or to agents that do not inhibit the renin-angiotensin-aldosterone system (RAAS).
Investigators hypothesized that lowering blood pressure with the RAAS inhibitor valsartan (an angiotensin receptor blocker) would improve diastolic function to a greater extent than is achieved without inhibiting the RAAS. Diastolic dysfunction might represent an early measure of end-organ damage that can precede left ventricular hypertrophy (LVH) in patients with hypertension, explained Scott Solomon, MD, of Brigham and Women's Hospital, Boston, who presented the findings.
Both antihypertensives lowered blood pressure by >10 mm Hg and both improved diastolic function to a similar degree. After 38 weeks of treatment, diastolic function, as assessed by diastolic relaxation velocities, increased from 7.5 cm/s at baseline to 8.1 cm/s in the valsartan group and 8.0 cm/s in the non-RAAS inhibitor group. Improvements in diastolic function in both groups were accompanied by small but significant reductions in left ventricular mass, Dr. Solomon reported.
Change in Mitral Annular Relaxation Velocity (E') from Baseline to Follow-Up.
Dr. Solomon noted that, despite having hypertension, LVH was observed in only 4% of patients. “We thought we would have seen a higher prevalence of LVH and myocardial fibrosis and, if we had, we may have shown a more pronounced effect in the valsartan group. We may have seen a difference between the two groups if the condition of the population had not been so benign,” he speculated.
- © 2007 MD Conference Express
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