Pharmacologic Therapy for Heart Failure with Preserved Ejection Fraction

Cardiol Clin. 2022 Nov;40(4):473-489. doi: 10.1016/j.ccl.2022.06.004. Epub 2022 Sep 8.

Abstract

The management of heart failure with preserved ejection fraction (HFpEF) is rapidly evolving. The pharmacologic treatment of patients with HFpEF includes symptom management with diuretics and optimization of comorbidities, including hypertension, obesity, diabetes mellitus, and atrial fibrillation. Specific therapies, including angiotensin II receptor blockers, mineralocorticoid receptor antagonists, angiotensin receptor-neprilysin inhibitors, and sodium-glucose cotransporter-2 inhibitors, are well tolerated and can reduce the risk of HF hospitalization, particularly in those on the lower end of the HFpEF left ventricular ejection fraction spectrum. Ongoing trials should continue to inform optimal therapy in this evolving field.

Keywords: Heart failure with preserved ejection fraction; Pharmacologic therapy; State-of-the-art.

Publication types

  • Review

MeSH terms

  • Angiotensin Receptor Antagonists / pharmacology
  • Angiotensin Receptor Antagonists / therapeutic use
  • Diabetes Mellitus, Type 2* / drug therapy
  • Glucose / pharmacology
  • Glucose / therapeutic use
  • Heart Failure* / drug therapy
  • Humans
  • Mineralocorticoid Receptor Antagonists / pharmacology
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Neprilysin / pharmacology
  • Neprilysin / therapeutic use
  • Receptors, Angiotensin / therapeutic use
  • Sodium / pharmacology
  • Sodium / therapeutic use
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
  • Stroke Volume
  • Ventricular Function, Left

Substances

  • Angiotensin Receptor Antagonists
  • Mineralocorticoid Receptor Antagonists
  • Receptors, Angiotensin
  • Sodium-Glucose Transporter 2 Inhibitors
  • Sodium
  • Neprilysin
  • Glucose