Hypertension and heart failure with preserved ejection fraction. A past, present, and future relationship

Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent syndrome with high cardiovascular and non-cardiovascular morbidity and mortality. Hypertension (HT) is one of its major risk factors and participates in its origin, development, and prognosis. The guidelines do not set out specific treatments, as clinical trials show limitations. Hypertension control is fundamental in the prevention and treatment of HFpEF. The guidelines recommend renin-angiotensin system blockade as the mainstay of hypertension treatment in patients with HFpEF. Spironolactone and angiotensin receptor-neprilysin inhibitors are also recommended in some cases. There are also new treatments that are already indicated, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, and promising treatments such as finerenone. A phenotypic classification that allows for more targeted treatments and studies that cover pending issues are yet to be undertaken.