HFpEF: When Initial Therapy Has Not Relieved Congestion or Controlled Blood Pressure
Some patients with heart failure with preserved ejection fraction do not achieve the key clinical targets — relief of congestion and blood pressure control — on first-line therapy. In these cases, a structured next-line approach is warranted, guided by current evidence-based guidelines.
Previous line — goals not met
The initial regimen included a sodium-glucose cotransporter 2 inhibitor (empagliflozin), with diuretics for fluid retention and antihypertensive therapy where indicated. Despite this, clinical congestion was not relieved and/or blood pressure targets were not reached — the conditions that trigger escalation to a further treatment step.
Next-line approach (partial overview)
In selected patients — particularly those whose ejection fraction falls toward the lower end of the preserved range — guideline-directed therapy considers adding a receptor-targeted agent from one of several pharmacological classes to reduce the risk of hospitalization.
The full protocol specifies which agents, how to choose among them, and the complete clinical algorithm…
References
DOI: 10.1161/CIR.0000000000001063
- In selected patients with HFpEF, MRAs may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum.
- In selected patients with HFpEF, the use of ARB may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum.
- In selected patients with HFpEF, ARNi may be considered to decrease hospitalizations, particularly among patients with LVEF on the lower end of this spectrum.