Key result
Targeting systolic blood pressure <130 mmHg addresses central sympathovagal mechanisms driving HFpEF pathogenesis.
Why the study?
The burden of HFpEF is rising with aging and unhealthy lifestyles, and hypertension is a central contributor linking cardiovascular and metabolic abnormalities in HFpEF.
Does targeting sympathovagal imbalance and managing hypertension (SBP <130 mmHg) improve management of HFpEF?
Does targeting sympathovagal imbalance and managing hypertension (SBP <130 mmHg) improve management of HFpEF?
This review highlights the central role of hypertension and sympathovagal imbalance in HFpEF, supporting a target SBP <130 mmHg and suggesting a potential role for neuromodulatory therapies.
Answers are grounded in this paper and cite their sources.
Synthesizes hypertension-HFpEF links; leaves open targeted trials to guide management.
As population aging accelerates and unhealthy lifestyle habits become increasingly prevalent, the burden of heart failure with preserved ejection fraction (HFpEF) continues to rise. Hypertension, obesity, and atrial fibrillation (AF) are major contributors to the development and progression of HFpEF. Among these risk factors, hypertension serves as a central hub linking cardiovascular and metabolic abnormalities. This review discusses the relationship between hypertension and HFpEF, focusing on sympathovagal imbalance as a common mechanism underlying hypertension, obesity, and AF. We summarize evidence regarding the contribution of autonomic dysregulation to HFpEF pathogenesis and examine the therapeutic potential of targeting autonomic function. Current evidence suggests that a systolic blood pressure target of <130 mmHg may be appropriate for patients with HFpEF. In addition to established pharmacological therapies, emerging neuromodulatory approaches, particularly low-level transcutaneous tragus stimulation, may represent promising adjunctive treatment strategies. Improved understanding of these interrelated mechanisms may facilitate more individualized management of HFpEF.
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Nagai et al. (2026) conducted a review in Heart failure with preserved ejection fraction (HFpEF) and hypertension. Hypertension and blood pressure management was evaluated. Hypertension serves as a central mechanism in the pathogenesis of HFpEF, driven by sympathovagal imbalance, with current evidence suggesting a systolic blood pressure target of <130 mmHg.
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