From the Guidelines
Medical treatment for heart failure with preserved ejection fraction (HFpEF) should focus on symptom management and addressing underlying conditions, with a cornerstone of treatment including diuretics, blood pressure control, and management of comorbidities, as evidenced by the most recent study 1. The treatment approach for HFpEF involves several key components, including:
- Diuretics like furosemide (20-80mg daily) or hydrochlorothiazide (12.5-50mg daily) to reduce fluid overload and relieve symptoms such as shortness of breath and edema
- Blood pressure control, typically with ACE inhibitors like lisinopril (10-40mg daily) or ARBs such as valsartan (80-320mg daily)
- For patients with diabetes, SGLT2 inhibitors like empagliflozin (10mg daily) or dapagliflozin (10mg daily) have shown benefit in reducing hospitalizations, as noted in the study 1
- Beta-blockers such as metoprolol succinate (25-200mg daily) may help control heart rate and improve symptoms, particularly in patients with atrial fibrillation, as recommended in the guidelines 1
- Lifestyle modifications are crucial, including sodium restriction (<2g daily), regular physical activity, and weight management
- Treatment should also target specific comorbidities like atrial fibrillation, coronary artery disease, and hypertension Unlike heart failure with reduced ejection fraction, HFpEF lacks treatments that definitively improve mortality, making symptom management and addressing underlying conditions the primary focus, as highlighted in the study 1 Regular monitoring of kidney function, electrolytes, and symptom response is necessary to adjust medications appropriately, ensuring optimal management of HFpEF and minimizing morbidity and mortality.
From the Research
Medical Treatment for HFpEF
The medical treatment for Heart Failure with Preserved Ejection Fraction (HFpEF) involves various pharmacotherapies, including:
- Diuretics: reduce congestion in patients with HFpEF 2
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i): reduce the risk of composite cardiovascular events, driven by a reduction in HF hospitalisations 3
- Renin-angiotensin-aldosterone blockers and angiotensin-neprilysin inhibitors: result in smaller reductions in HF hospitalisations among patients with HFpEF 3
- Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB): associated with lower 1-year mortality risk and lower 1-6-year mortality risk in patients with HFpEF 4
- Mineralocorticoid receptor antagonists (MRAs): reduce the risk of HF hospitalization 5
- Beta-blockers: not associated with improved cardiovascular or all-cause mortality in HFpEF 5
Treatment Approaches
Treatment approaches for HFpEF include:
- Pharmacologic interventions: such as diuretics, SGLT2i, and MRAs 2, 3, 5
- Nonpharmacologic interventions: such as exercise and risk factor modification 6
- Risk factor modification: intensive optimization of HFpEF risk factors 6
- Referral to a dedicated HFpEF center or advanced heart failure specialist: for complex cases 6
Ongoing Research
There are ongoing trials evaluating the efficacy and safety of different classes of diuretics, including loop diuretics, MRAs, and SGLT2i, in patients with HFpEF 2. Additionally, network meta-analyses are being conducted to compare the efficacy of different pharmacotherapies in HFpEF 5.