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ObjectivesWe investigated whether diastolic function differs between hypertensive patients of African-Caribbean or white European origin and established whether differences could be explained by confounding variables.BackgroundAfrican Caribbeans are known to have a higher prevalence of heart failure than white Europeans but it is unclear whether this is a result of known risk factors. Tissue Doppler technology now allows accurate quantification of diastolic function, which is recognized as an important factor in the development of heart failure.MethodsParticipants from a single center participating in the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial), composed of patients with hypertension but no evidence of heart failure, were studied. Left ventricular structure and function were measured in 509 patients using conventional and tissue Doppler echocardiography. Diastolic function was assessed using the tissue Doppler early diastolic velocity E′ (averaged from 3 left ventricular segments) and the ratio of this and the transmitral early filling velocity E (E/E′).ResultsIn African-Caribbean patients, mean E′ was significantly lower (7.7 cm/s vs. 8.6 cm/s, p = 0.003) and mean E/E′ was significantly higher (8.85 vs. 7.93, p = 0.003). After adjustment for confounding variables—age, gender, systolic blood pressure, pulse pressure, cholesterol, smoking, ejection fraction, left ventricular mass index, and diabetes mellitus—the effect of African-Caribbean ethnicity on diastolic function remained highly significant (E′: 7.52 vs. 8.51; p < 0.001; E/E′: 8.89 vs. 7.93; p = 0.003; African Caribbeans vs. white Europeans for both comparisons).ConclusionsDiastolic function is significantly worse in hypertensive patients of African-Caribbean origin than in white Europeans. This difference in diastolic performance is not due to known confounding variables.

ObjectivesWe hypothesized that an amlodipine-based regimen would have more favorable effects on left ventricular (LV) diastolic function.BackgroundDifferent antihypertensive therapies may vary in their effect on LV diastolic function.MethodsThe HACVD (Hypertension Associated Cardiovascular Disease) substudy of ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) collected detailed cardiovascular phenotypic data on a subset of 1,006 participants recruited from 2 centers (St. Mary's Hospital, London, and Beaumont Hospital, Dublin). Conventional and tissue Doppler echocardiography and measurement of plasma B-type natriuretic peptide (BNP) were performed approximately 1 year after randomization to atenolol-based or amlodipine-based antihypertensive treatment to assess LV diastolic function.ResultsOn-treatment blood pressure (BP) (mean ± SD) was similar in both groups: atenolol-based regimen, systolic BP of 137 ± 17 mm Hg, diastolic BP of 82 ± 9 mm Hg; amlodipine-based regimen, systolic BP of 136 ± 15 mm Hg, diastolic BP of 80 ± 9 mm Hg. Ejection fraction did not differ between groups, but early diastolic mitral annular velocity (E′), a measure of diastolic relaxation, was lower in patients on the atenolol-based regimen: atenolol-based regimen, 7.9 ± 1.8; amlodipine-based regimen, 8.8 ± 2.0. A measure of left ventricular filling pressure, E/E′, and BNP were significantly higher in patients on the atenolol-based regimen. Differences in E′, E/E′, and BNP remained significant after adjustment for age and sex. Further adjustment for systolic BP, LV mass index, and heart rate had no impact on differences in mean E′ or BNP. The difference in E/E′ was attenuated.ConclusionsPatients receiving treatment with an amlodipine-based regimen had better diastolic function than patients treated with the atenolol-based regimen. Treatment-related differences in diastolic function were independent of BP reduction and other factors that are known to affect diastolic function.