Do SGLT2 inhibitors and intensive blood pressure management improve outcomes in patients with hypertensive heart failure with preserved ejection fraction?
This narrative review highlights critical evidence gaps in optimal blood pressure targets and SGLT2i use specifically for hypertensive HFpEF, advocating for dedicated RCTs.
Hypertension is among the most important modifiable risk factors associated with heart failure with preserved ejection fraction (HFpEF) development and progression, yet guideline-directed blood pressure (BP) targets ( 75 years) complicating aggressive BP management. The review addresses phenotype-specific challenges through precision medicine approaches incorporating phenomapping and multi-biomarker panels (NRI 0.28 improvement). We advocate for dedicated HFpEF RCTs evaluating intensive vs. standard BP targets, SGLT2i sequencing with antihypertensives, and European real-world registries to bridge the translational gap. These strategies aim to transform guideline recommendations into optimized, patient-centered care for the rapidly expanding hypertensive HFpEF population.
Mavraganis et al. (Wed,) studied this question.