Preserved ejection fraction heart failure

WHO group II patients with pulmonary venous hypertension include patients with systolic heart failure, preserved ejection fraction heart failure (PEFHF), valvular heart disease, and hypertrophic, restrictive, or infiltrative cardiomyopathies. Particular care should be... 

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

Unlike systolic HF, few prospective trials have evaluated the safety and efficacy of various cardiac medications in patients with diastolic HF or preserved ejection fraction. The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) study demonstrated that angiotensin receptor blockade with candesartan resulted in beneficial effects on HF morbidity in patients with preserved LVEF similar to those seen in depressed LV function.25... 

Most clinical trials have been carried out in patients with systolic dysfunction, so the evidence regarding the superiority or inferiority of drugs in heart failure with preserved ejection fraction is meager. Most authorities support the use of the drug groups described above. Control of hypertension is particularly important, and revascularization should be considered if coronary artery disease is present. Tachycardia limits filling time therefore bradycardic drugs may be particularly useful, at least in theory. 

Zile MR. Heart failure with preserved ejection fraction Is this diastolic heart failure 1 Am Coll Cardiol 2003 41 1519—1522. 

Maisel AS, McCord J, Nowak RM, et al. Bedside B-type natriuretic peptide in emergency diagnosis of heart failure with reduced or preserved ejection fraction. J Am Coll Cardiol 2003 41 2010-2017. 

HF, heart failure HTN, hypertension ADHF, acute decompensated heart failure PEFHF, preserved ejection fraction HF, heart failure. 

Morgan, S., Watson, C., Glezeva, N., and Baugh, J. (2014) Murine models of diastolic dysfunction and heart failure with preserved ejection fraction. J. Card. Fail. 20, 984—995. 

Heart failure is a major public health concern (Gedela et al. 2015). It has been recently categorized into heart failure with reduced and preserved ejection fraction mortality remains similarly high for both conditions. 

Howard PA (2015) Treating heart failure with preserved ejection fraction a challenge for clinicians. Hosp Pharm 50 454-459... 

Solomon SD, Zile M, Pieske B, Voors A, Shah A, Kraigher-Krainer E, et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction a phase 2 double-blind randomised controlled trial. Lancet 2012 380 1387-95. 

Heart Failure with Preserved Left Ventricular Ejection Fraction... 

Yusuf S, Pfeffer MA, Swedberg K, et al, Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction the CHARM-Preserved trial, Lancet 2003 362 777-781. 

The effects of furosemide withdrawal on postprandial blood pressure have been assessed in 20 elderly patients (mean age 73 years) with heart failure and preserved left ventricular systolic function (ejection fraction 61%) (23). In 13 who were able to discontinue furosemide (mean dose 32 mg/day), maximum systolic blood pressure fell significantly from 25 mmHg to 11 mmHg and diastolic blood pressure from 18 to 9 mmHg over 3 months. In the continuation group (mean furosemide dose 21 mg/day), there was no change in the postprandial fall. 

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