title: Changes in left ventricular relaxation after azelnidipine treatment in hypertensive patients with diabetes: subanalysis of a prospective single-arm multicentre study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Subanalysis of a prospective single-arm multicentre study.
  
  
  METHODS
  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.
  
  
  METHODS
  Administration of 16 mg of azelnidipine for 8 months (range 6-10 months).
  
  
  METHODS
  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.
authors.affiliation: Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors.forename: Katsuomi
authors.identifier: http://orcid.org/0000-0001-6617-1521
authors.initials: K
authors.lastname: Iwakura
authors.affiliation: Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.affiliation: Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
authors.forename: Motoo
authors.initials: M
authors.lastname: Date
authors.affiliation: Division of Medicine, Ibaraki Iseikai Hospital, Ibaraki, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Nakamura
authors.affiliation: Department of Internal Medicine, Iwasa Dai-ichi Hospital, Gifu, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nagano
authors.affiliation: Department of Cardiology, Higashi-Takarazuka Satoh Hospital, Takarazuka, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Takiuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001383:Azetidinecarboxylic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D058065:Diabetic Cardiomyopathies / Q000188:drug therapy*; D004095:Dihydropyridines / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D001383:Azetidinecarboxylic Acid; C061679:azelnidipine