Renin–angiotensin inhibitors, mineralocorticoid antagonists, and SGLT2 inhibitors benefit heart failure patients with obesity across BMI groups, without major safety concerns.
How should guideline-directed medical therapy be implemented and monitored in patients with heart failure and obesity?
This expert consensus document provides a comprehensive framework for the tailored use, patient selection, and monitoring of guideline-directed medical therapy in patients with heart failure and obesity.
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Abstract Obesity is prevalent among patients with heart failure (HF), especially in those with preserved ejection fraction (HFpEF), and complicates diagnosis, therapy, and monitoring. It alters haemodynamics, biomarker interpretation, and drug pharmacokinetics, potentially influencing treatment response. Evidence from subgroup analyses of major HF trials suggests that renin–angiotensin system inhibitors (mainly sacubitril-valsartan), mineralocorticoid receptor antagonists, and sodium–glucose cotransporter 2 inhibitors provide consistent benefits across body mass index (BMI) categories, with no major obesity-specific safety concerns. In contrast, data on beta-blockers in obese HF patients remains limited, largely reflecting the older design of pivotal trials. Management should include careful assessment of congestion, acknowledging the limitations of physical examination, natriuretic peptides, and imaging, while implementing tailored diuretic strategies. This expert consensus provides a comprehensive and pragmatic framework for the use of guideline-directed medical therapy in patients with HF and obesity, exploring the available evidence for each drug class and addressing efficacy, patient selection, safety, and monitoring.
Monzo et al. (Wed,) reported a other. Renin–angiotensin inhibitors, mineralocorticoid antagonists, and SGLT2 inhibitors benefit heart failure patients with obesity across BMI groups, without major safety concerns.