Related Experiment Video

Updated: Aug 5, 2026

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs
07:09

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs

Published on: February 18, 2022

Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence

Georgios Mavraganis1,2, Christos Fragoulis1, Georgios Georgiopoulos2

  • 1First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.

Medicina (Kaunas, Lithuania)
|July 28, 2026
PubMed

Insights

Hypertension significantly contributes to heart failure with preserved ejection fraction (HFpEF). While sodium-glucose co-transporter 2 inhibitors (SGLT2i) show promise in reducing HF events, dedicated trials and optimized blood pressure management are needed for hypertensive HFpEF patients.

Area of Science:

  • Cardiology and Cardiovascular Research
  • Hypertension and Heart Failure Pathophysiology
  • Pharmacological Interventions in Cardiovascular Disease

Background:

  • Hypertension is a critical modifiable risk factor for heart failure with preserved ejection fraction (HFpEF) development and progression.
  • Current guideline-directed blood pressure targets and therapies like sodium-glucose co-transporter 2 inhibitors (SGLT2i) lack dedicated randomized controlled trials (RCTs) specifically for the HFpEF population.

Purpose of the Study:

  • To synthesize current evidence on hypertension management in HFpEF, addressing pathophysiological links, therapeutic efficacy, and evidence gaps.
  • To discuss the role of SGLT2 inhibitors and blood pressure targets in hypertensive HFpEF patients.
  • To advocate for future research and precision medicine approaches for optimized patient-centered care.

Main Methods:

  • Narrative review synthesizing recent meta-analyses (ESC/ESH 2024, JSH 2025) and landmark trial post hoc analyses (EMPEROR-Preserved, DELIVER).
  • Discussion of pathophysiological frameworks, biomarker utility (sST2, NT-proBNP), and device therapy data (renal denervation).
  • Analysis of real-world implementation barriers and Hellenic HF Registry data on frailty.

Main Results:

  • SGLT2 inhibitors demonstrated consistent heart failure event reductions (pooled HR 0.79) with modest systolic blood pressure lowering (-2.3 mmHg).
  • Biomarkers like sST2 and NT-proBNP aid risk stratification but are not specific to hypertension-mediated remodeling.
  • Significant evidence gaps exist regarding optimal BP thresholds, device therapies, and real-world adherence in elderly/comorbid populations.

Conclusions:

  • Dedicated RCTs are crucial to evaluate intensive versus standard BP targets and SGLT2i sequencing in hypertensive HFpEF.
  • Precision medicine approaches, including phenomapping and multi-biomarker panels, can address phenotype-specific challenges.
  • European real-world registries are needed to bridge the translational gap and optimize care for the growing hypertensive HFpEF population.

Keywords:
HFpEFSGLT2 inhibitorsbiomarkersdiastolic dysfunctionheart failurehypertensionprecision medicinerenal denervation

Related Concept Videos

Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.