Current status on the role of beta blocker in HFpEF: A Reappraisal

Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and is increasingly recognized as a complex clinical syndrome driven by diverse pathophysiological mechanisms and multiple comorbidities. Despite its growing prevalence, evidence supporting disease-modifying therapies in HFpEF remains limited. Beta-blockers continue to be widely used in this population, largely for indications such as hypertension, atrial fibrillation, ischemic heart disease, and elevated heart rate; however, their therapeutic value in HFpEF itself remains uncertain.

This narrative review summarizes current clinical evidence on role of beta blocker in phenotype driven HFpEF management. A thorough search of Pubmed has been done using the key words "heart failure with preserved ejection fraction", "heart failure comorbidities", and "beta blockers in heart failure".

It was found that an all HFpEF trials for new pharmacological agents like SGLT2I, ARNI, MRA and nsMRA, beta blocker therapy had been there during screening in 80-90% of patients with HFpEF. Neither the reasons were explored nor the Beta blockers were withdrawn for inclusion in the studies.

Current evidence suggests that beta-blockers can be prescribed based on comorbidity profiles rather than as HFpEF specific therapy. Well-designed randomized studies particularly those incorporating phenotype-based patient selection are needed to clarify the therapeutic role of beta-blockers.