What does this research mean for the field?

Although SGLT2 inhibitors consistently reduce heart failure events in HFpEF, significant evidence gaps persist regarding optimal blood pressure targets and therapeutic sequencing in hypertensive HFpEF due to a lack of dedicated randomized trials. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To identify gaps between guidelines and randomized controlled trials evidence for managing hypertension in heart failure with preserved ejection fraction (HFpEF).

June 25, 2026MedicinaOpen Access

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

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Why the study?

Guideline-directed blood pressure targets (<130/80 mmHg) and SGLT2 inhibitor therapies lack dedicated randomized controlled trials in hypertensive HFpEF patients.

Do SGLT2 inhibitors and intensive blood pressure management improve outcomes in patients with hypertensive heart failure with preserved ejection fraction?

Design

Narrative review

Authors

GMGeorgios MavraganisGeneral / Preventive / Lipids CFChristos FragoulisGeneral / Preventive / Lipids GGGeorgios GeorgiopoulosPreventive Cardiology

Discussion

Member takes

Implication

Supports SGLT2i in HFpEF despite low-certainty evidence; leaves open dedicated RCTs for BP targets and therapies.

Key Points

To identify gaps between guidelines and randomized controlled trials evidence for managing hypertension in heart failure with preserved ejection fraction (HFpEF).
Synthesis of ESC/ESH and JSH meta-analyses from 2024 and 2025.
Post hoc analyses from landmark trials (EMPEROR-Preserved, DELIVER) for SGLT2i efficacy.
Assessment of biomarkers and device therapy data, focusing on real-world complexities in elderly patients.
Pooled HR for SGLT2i reducing heart failure events was 0.79 (95% CI 0.67–0.93).
Systolic blood pressure was modestly lowered by −2.3 mmHg with SGLT2i use.
68% frailty prevalence in patients over 75 complicates management, with adherence rates under 50%.

Structured PICO

Do SGLT2 inhibitors and intensive blood pressure management improve outcomes in patients with hypertensive heart failure with preserved ejection fraction?

Population

Patients with hypertensive heart failure with preserved ejection fraction (HFpEF)

Intervention

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and intensive blood pressure management

Comparator

Standard care / standard blood pressure targets

Outcome

Heart failure events

This narrative review highlights critical evidence gaps in optimal blood pressure targets and SGLT2i use specifically for hypertensive HFpEF, advocating for dedicated RCTs.

Limitations

Heterogeneous BP thresholds across international guidelines
Limited device therapy data
Real-world implementation barriers among elderly/comorbid Europeans (adherence < 50%, polypharmacy risks)
Frailty complicating aggressive BP management

Cite This Study

Mavraganis et al. (2026) studied this question.

synapsesocial.com/papers/6a3d91bf408ebb922448b18f https://doi.org/10.3390/medicina62071222

Topics

Hypertension management SGLT2 inhibitors in heart failure

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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