Key result
Beta-blockers do not improve quality of life or survival in HFpEF across 58 reviewed studies and may increase the risk of heart failure hospitalization.
Why the study?
Medical management of heart failure with preserved ejection fraction (HFpEF) remains uncertain, as beta-blockers have shown varied outcomes across studies.
Do beta-blockers improve survival, reduce heart failure hospitalizations, or improve quality of life in patients with heart failure with preserved ejection fraction (HFpEF)?
Do beta-blockers improve survival, reduce heart failure hospitalizations, or improve quality of life in patients with heart failure with preserved ejection fraction (HFpEF)?
This narrative review of 58 studies reinforces current guidelines that routine beta-blocker therapy is not recommended for HFpEF due to a lack of mortality or quality-of-life benefit and a potential increase in HF hospitalizations, unless indicated for specific comorbidities like atrial fibrillation, hypertension, or coronary artery disease.
Answers are grounded in this paper and cite their sources.
Caution against routine beta-blockers in HFpEF; supports guidelines from Level 5 evidence yet leaves open dedicated RCTs.
Background: Medical management of Heart failure with preserved ejection fraction (HFpEF) remains uncertain, especially beta blockers (BBs) had various outcomes in studies. The objective of the present study is to review the efficacy and prognostic role of BBs in patients with HFpEF. Methods: A total of 58 articles were chosen for this narrative review from sources including web of science, PUBMED and Google Scholar. Results: Patients with HFpEF are more prevalent in female. The average age of patients is usually 70-80 years. The most important risk factors for this condition include advanced age, female gender, hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and atrial fibrillation (AF). Despite a lack of evidence or indication, BBs are still extensively prescribed in HFpEF. In patients with HFpEF, BBs reduce blood pressure, left ventricular hypertrophy, and diastolic dysfunction by slowing heart rate and myocardial oxygen demand. BBs reduce blood pressure, but despite this, they do not improve the quality of life, cardiovascular events, and all-cause mortality. BBs may even be associated with an increased risk of HF hospitalization. In some studies, Carvedilol and Nebivolol were associated with improvement of functional capacity, NT Pro-BNP levels, and survival. Overally, using the BBs, recommended for patients of HFPEF with atrial fibrillation, hypertension, and coronary artery disease. Conclusion: BBs does not have a beneficial effect on quality of life and survival, and is also linked to a higher risk of HF-related hospitalizations. The use of BBs is not recommended for the treatment of HFpEF.
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Khederlou et al. (2026) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Beta-blockers vs. No beta-blocker therapy, placebo, or beta-blocker withdrawal was evaluated on Quality of life, cardiovascular events, heart failure hospitalization, and all-cause mortality. Beta-blockers do not improve quality of life or survival in HFpEF across 58 reviewed studies and may increase the risk of heart failure hospitalization.
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