Principles of Management of Diastolic Heart Failure*
| Goal | Therapy |
|---|---|
| Reduction of congestion | Salt restriction |
| Less than 2 g daily | |
| Diuretics | |
| Thiazides and loop diuretics | |
| ACEIs | |
| Enalapril | |
| Lisinopril | |
| ARBs | |
| Candesartan | |
| Losartan | |
| Maintenance of rate control | β-blockers |
| Atenolol, metoprolol | |
| Calcium channel blockers | |
| Diltiazem, verapamil | |
| Conversion of atrial fibrillation | |
| Atrioventricular pacing | |
| Optimal management of hypertension | Antihypertensive agents |
| β-blockers | |
| Calcium channel blockers | |
| Diuretics | |
| ACEIs | |
| ARBs | |
| Spironolactone | |
| Prevention and treatment of myocardial ischemia | β-blockers |
| Atenolol, metoprolol | |
| Calcium channel blockers | |
| Diltiazem, verapamil | |
| Nitrates | |
| Isosorbide dinitrate | |
| Isosorbide mononitrate | |
| Revascularization | |
| Percutaneous transluminal | |
| coronary angioplasty, coronary | |
| artery bypass surgery |
* This information is based on the authors’ experience and a review of the literature regarding diastolic heart failure (DHF). It should be emphasized that the literature is incomplete. With the exception of the CHARM study, no randomized controlled trial (RCT) has specifically evaluated the efficacy of a specific agent in the treatment of DHF. Most studies were designed to evaluate a drug in the treatment of systolic heart failure (SHF) and were not specifically designed to assess their efficacy in DHF patients. These studies and an understanding of the pathophysiology of DHF form the basis of current discussion of therapy in the cardiology literature.
ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; β-blocker, β-adrenergic receptor blocker.