Key result
Beta-blockers are present in 80-90% of HFpEF trial patients, likely prescribed for comorbidities rather than HFpEF.
Why the study?
Beta-blockers are widely used in HFpEF for associated comorbidities, but their therapeutic value in HFpEF itself remains uncertain.
Current evidence suggests that beta-blockers in HFpEF should be prescribed based on comorbidity profiles rather than as a specific disease-modifying therapy.
Beta-blocker use in HFpEF remains uncertain; leaves open the need for dedicated RCTs to guide practice.
BACKGROUND: 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. METHOD: 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". RESULT: 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 Neither the reasons were explored nor the Beta blockers were withdrawn for inclusion in the studies. CONCLUSION: 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.
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Ray et al. (2026) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Beta-blockers was evaluated. Beta-blockers were present at screening in 80-90% of patients in HFpEF trials for new pharmacological agents, suggesting they are prescribed for comorbidities rather than as HFpEF-specific therapy.
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