title: Treatment of heart failure with preserved ejection fraction: have we been pursuing the wrong paradigm?
abstract: Heart failure with preserved ejection fraction (HF-PEF) is the clinical syndrome of heart failure associated with normal or near-normal systolic function. Because inhibition of the adrenergic and renin-angiotensin-aldosterone systems has been so effective in the treatment of systolic heart failure, these same therapies have been the subject of recent clinical trials of HF-PEF. In this review, we examine the current evidence about treatment of HF-PEF, with particular emphasis on reviewing the literature for large-scale randomized clinical studies. The lack of significant benefit with neurohormonal antagonism in HF-PEF suggests that this condition might not involve neurohormonal activation as a critical pathophysiologic mechanism. Perhaps heart failure as we traditionally think of it is the wrong paradigm to pursue as we try to understand this condition of volume overload known as HF-PEF.
authors.affiliation: Division of Cardiovascular Medicine, University Hospitals of Cleveland, Case Medical Center, Cleveland, OH, USA. gerard.oghlakian@UHhospitals.org
authors.forename: Gerard O
authors.initials: GO
authors.lastname: Oghlakian
authors.forename: Ilke
authors.initials: I
authors.lastname: Sipahi
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
mesh_terms: 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; D001562:Benzimidazoles / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004071:Digitalis Glycosides / Q000627:therapeutic use; D015444:Exercise; D017079:Exercise Tolerance; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy / Q000503:physiopathology; D000077405:Irbesartan; D000451:Mineralocorticoid Receptor Antagonists; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013318:Stroke Volume; D013777:Tetrazoles / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000503:physiopathology; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D004071:Digitalis Glycosides; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013777:Tetrazoles; D014700:Verapamil; D000077405:Irbesartan; C081643:candesartan