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Table 19. Pharmacological Treatment for Stage C HFpEF:
Recommendations (2017)
COR
LOE Recommendations
I B Systolic and diastolic blood pressure should be controlled in
patients with HFpEF in accordance with published clinical practice
guidelines to prevent morbidity.
I C Diuretics should be used for relief of symptoms due to volume
overload in patients with HFpEF.
IIa C Coronary revascularization is reasonable in patient with CAD in
whom symptoms (angina) or demonstrable myocardial ischemia is
judged to be having an adverse effect on symptomatic HFpEF despite
GDMT.
IIa C Management of AF according to published clinical practice
guidelines in patients with HFpEF is reasonable to improve
symptomatic HF.
IIa C e use of beta-blocking agents, ACE inhibitors, and ARBs in
patients with hypertension is reasonable to control blood pressure in
patients with HFpEF.
IIb B-R In appropriately selected patients with HFpEF (with EF ≥45%,
elevated BNP levels or HF admission within 1 year, estimated
glomerular filtration rate >30 mL/min, creatinine <2.5 mg/dL,
potassium <5.0 mEq/L), aldosterone receptor antagonists might be
considered to decrease hospitalizations.
IIb B e use of ARBs might be considered to decrease hospitalizations for
patients with HFpEF.
III: No
Benefit
B-R Routine use of nitrates or phosphodiesterase-5 inhibitors to increase
activity or QoL in patients with HFpEF is ineffective.
III: No
Benefit
C Routine use of nutritional supplements is not recommended for
patients with HFpEF.
