title: Age and the effectiveness of anti-hypertensive therapy on improvement in diastolic function.
abstract: OBJECTIVE
  Diastolic dysfunction is associated with adverse outcomes and is highly prevalent among older adults with hypertension. Lowering SBP with antihypertensive therapy has been shown to improve diastolic function, but whether or not age influences this effect is unknown.
  
  
  METHODS
  In the Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction trial, 189 patients (age range 45-93 years) with hypertension and diastolic dysfunction underwent echocardiography before and after 24 weeks of intensive versus standard antihypertensive therapy titrated to a goal SBP below 135 versus below 140  mmHg. We performed linear regression analyses to examine the association between age and improvement in diastolic function achieved with SBP reduction.
  
  
  RESULTS
  Antihypertensive therapy reduced SBP by 28 ± 19  mmHg overall, and this was not significantly different across age strata. However, percentage improvement in diastolic relaxation velocity (lateral E' peak velocity) for every 10  mmHg reduction in SBP was lower in older compared to younger patients. In analyses adjusting for age stratum, sex, treatment arm, baseline relaxation velocity, and baseline blood pressure, older age was associated with reduced improvement in diastolic relaxation velocity per 10  mmHg of SBP reduction (β -1.64, P = 0.009). In contrast, the degree of change in left ventricular mass index per 10  mmHg reduction in SBP was not influenced by age (P = 0.89).
  
  
  CONCLUSIONS
  In our sample of individuals with hypertension and diastolic dysfunction, older compared to younger adults experienced less improvement in diastolic function in response to similar reductions in SBP.
authors.affiliation: aBrigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA bNational University Health System, Singapore cNovartis, East Hanover, New Jersey dState University of New York at Buffalo, Buffalo, New York eUniversity of Alabama, Birmingham, Alabama fUniversity of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lam
authors.forename: Amil
authors.initials: A
authors.lastname: Shah
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.forename: Akshay
authors.initials: A
authors.lastname: Desai
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hilkert
authors.forename: Joseph
authors.initials: J
authors.lastname: Izzo
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003971:Diastole / Q000187:drug effects*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents