Question: In addition to dietary salt restriction and diuretics, what else should be used in the treatment of diastolic heart failure?
Answer: Well, that's a very good question and unfortunately we don't have a perfect answer. In contrast to systolic heart failure where we have many proven therapies, we have very few in diastolic heart failure.
Most would agree that it's very important to control hypertension -- high blood pressure. And there are a number of different agents which do this. The two most commonly used in systolic heart failure are ACE inhibitors and Angiotensin Receptor Blockers or ARBs. These have also been studied in smaller sized trials of patients with diastolic heart failure and there's a trend towards improvements with reduction in hospitalizations, but it's not as overwhelmingly effective as it is in systolic heart failure. Nonetheless, in the absence of other data, these would be the agents we would go to first.
Many physicians would also recommend that we slow the heart rate as much as possible to increase the filling time for the ventricle because in diastolic heart failure there's stiffening and impairments in filling the heart during the relaxation phase.
However, there's other data where we've shown that many of these patients have an inability to increase their heart rate with stress of exercise. So, this is something that's very much a moving target and probably needs to be individualized for different patients.