Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction: Clinical Relevance, Management, and Future Directions

There are currently 6 million Americans with heart failure, and this number is projected to increase to 8.5 million by 2030. One-half of patients with heart failure have preserved ejection fraction (HFpEF), and the prevalence is increasing. HFpEF can lead to secondary pulmonary hypertension (PH-HFpEF) and is associated with a worsened disease trajectory when present. It is unclear, however, whether PH is a marker of disease severity or a target of treatment in HFpEF. As PH-HFpEF and pulmonary arterial hypertension share several clinical characteristics, the distinction between these 2 syndromes can be difficult. New classification schemes have been proposed to separate those with passive elevations in pulmonary artery pressures from those with more significant pulmonary vascular remodeling. While these classifications have limitations, they are necessary such that pathophysiology, disease trajectory, and pharmacologic therapies can be studied in specific patient subgroups. In this article, we will review the epidemiology of HFpEF, current definitions for both HFpEF and PH in HFpEF, treatment options, and ongoing clinical trials.