Beta-Blockers in Heart Failure With Preserved Ejection Fraction: A Declining Role in Contemporary Management.

Area of Science:

• Cardiology
• Pharmacology

Background:

• Heart failure with preserved ejection fraction (HFpEF) is a growing clinical challenge, comprising nearly half of heart failure diagnoses.
• HFpEF is characterized by impaired diastolic function, reduced exercise capacity, and increased mortality, particularly in elderly patients with comorbidities.

Purpose of the Study:

• To synthesize current data on beta-blocker (BB) use in HFpEF.
• To explore the mechanistic rationale, clinical indications, and potential harms of BBs in HFpEF.
• To clarify the uncertain and controversial role of BBs in HFpEF management.

Main Methods:

• This narrative review synthesizes existing data from randomized trials, observational studies, and meta-analyses.
• It examines the mechanistic rationale behind BB use in HFpEF.
• The review clarifies clinical indications and potential adverse effects.

Main Results:

• BBs are historically used in heart failure with reduced ejection fraction (HFrEF) with proven mortality benefits.
• In HFpEF, BBs are used for comorbidities like atrial fibrillation and ischemic heart disease.
• Emerging research suggests BBs may amplify chronotropic incompetence and reduce cardiac output in certain HFpEF phenotypes, potentially worsening symptoms.

Conclusions:

• The role of BBs in HFpEF remains uncertain and controversial.
• While BBs manage comorbidities, their use may carry risks in specific HFpEF populations.
• Further targeted research is essential to define appropriate BB use in HFpEF.