Advances in the treatment of heart failure with a preserved ejection fraction.
OBJECTIVE
Heart failure with preserved ejection fraction (HF-PEF) occurs in approximately 50% of patients with heart failure (HF) and is associated with high morbidity and mortality. A recent study demonstrated that, although survival improved significantly over time among HF patients with reduced ejection fraction (EF), there was no such trend toward improvement among patients with HF-PEF. Therefore, there exists an urgent need to develop effective treatment strategies specifically for patients with HF-PEF. Recently completed and ongoing research in the treatment of HF-PEF is reviewed in this article.


RESULTS
The two large randomized clinical trials completed in HF-PEF patients did not achieve statistical significance in benefit of renin-angiotensin system blockade on their primary combined endpoints of morbidity and mortality. Both trials, however, suggested the benefit of the angiotensin receptor and angiotensin-converting enzyme blockade on HF hospitalization. In addition, no clear benefit of beta-blockers has been demonstrated specifically in patients with HF-PEF.


CONCLUSIONS
Current therapeutic recommendations for HF-PEF are aimed mostly at symptomatic management and treatment of concomitant comorbidities. Results of ongoing clinical trials further evaluating inhibition of the angiotensin and the aldosterone receptors as well as examining other novel therapeutic targets in HF-PEF are keenly awaited.
Das
Aparajita
A
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Abraham
Selwin
S
Deswal
Anita
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors