Diastolic dysfunction in hypertension: a comprehensive review of pathophysiology, diagnosis, and treatment.

Diastolic dysfunction refers to impaired relaxation or filling of the ventricles during the diastolic phase of the cardiac cycle. Left ventricular diastolic dysfunction (LVDD) is common in hypertensive individuals and is associated with increased morbidity and mortality. LVDD serves as a critical precursor to heart failure, particularly heart failure with preserved ejection fraction. The pathophysiology of LVDD in hypertension is complex, involving alterations in cardiac structure and function, neurohormonal activation, and vascular stiffness. While the diagnosis of LVDD relies primarily on echocardiography, management remains challenging due to a lack of specific treatment guidelines for LVDD. This review offers an overview of the pathophysiological mechanisms underlying LVDD in hypertension, diagnostic methods, clinical manifestations, strategies for managing LVDD, and prospects for future research.
Competing Interests: Conflict of interest: M.F. was supported by the NIH, Alleviant, Gradient, Reprieve, Sardocor, and Doris Duke. He is a consultant/has ownership interest in Abbott, Alleviant, Cardioflow, Daxor, Feldschuh Foundation, Gradient, Impulse Dynamics, Medtronic, Merck, Novo Nordisk, Orchestra, Pharmacosmos, ReCor, SCPharma, Shifamed, Summacor, SyMap, and Zoll. T.B.-S. has served as chief investigator of the Sanofi financed NUDGE-FLU trial, the Sanofi financed DANFLU-1 trial, and the Sanofi financed DANFLU-2 trial. He has served as a steering committee member of the Amgen financed GALACTIC-HF trial, the Boston Scientific financed LUX-D × TRENDS trial, and the Boehringer Ingelheim financed EASi-KIDNEY trial. He has also served on advisory boards for Sanofi, GSK, Amgen, and CSL Squirus. He has received speaker honoraria from Bayer, GSK, Novartis, GE Healthcare, and Sanofi. He has consulted for Novo Nordisk, IQVIA, and Parexel, and received research grants from GE Healthcare, Sanofi, Boston Scientific, AstraZeneca, and Novo Nordisk.
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