A study, published in the Japanese Circulation Journal, evaluated the mechanisms of improvement in left ventricular (LV) diastolic function in hypertensive patients treated with cilnidipine using pulsed Doppler echocardiography and pulsed tissue Doppler imaging. In all, 35 untreated patients with essential hypertension were recruited. Researchers evaluated the peak early diastolic and atrial systolic transmitral flow velocities (E and A, respectively) and their ratio (E/A), and the peak early diastolic and atrial systolic motion velocities (Ew and Aw, respectively) of the LV posterior wall and their ratio (Ew/Aw) in all patients before and after 1, 3 and 6 months of cilnidipine (10 mg/day). At 1 month, systolic and diastolic BPs were significantly decreased. E and E/A were found to increase significantly, while there were no significant changes in Ew and Ew/Aw. At 3 months, Ew and Ew/Aw significantly increased when compared to the value before and 1 month after cilnidipine. At 6 months, E and E/A were significantly increased in comparison with before and 3 months after cilnidipine, and Ew and Ew/Aw were significantly increased compared with the value before cilnidipine. The LV mass index was found to be significantly reduced compared to that before cilnidipine. The changes in LV diastolic performance in patients with essential hypertension following cilnidipine therapy were biphasic; there was an initial elevation in early diastolic transmitral flow velocity and a later increase in early diastolic LV wall motion velocity.