Saumitra Ray, Satyavir Yadav, Nitish Naik, Srina Ray
Current evidence suggests that beta-blockers can be prescribed based on comorbidity profiles rather than as HFpEF specific therapy. Well-designed randomized studies particularly those incorporating phenotype-based patient selection are needed to clarify the therapeutic role of beta-blockers.
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and is increasingly recognized as a complex clinical syndrome driven by diverse pathophysiological mechanisms and multiple comorbidities. Despite its growing prevalence, evidence supporting disease-modifying therapies in HFpEF remains limited. Beta-blockers continue to be widely used in this population, largely for indications such as hypertension, atrial fibrillation, ischemic heart disease, and elevated heart rate; however, their therapeutic value in HFpEF itself remains uncertain.
METHOD: This narrative review summarizes current clinical evidence on role of beta blocker in phenotype driven HFpEF management. A thorough search of Pubmed has been done using the key words "heart failure with preserved ejection fraction", "heart failure comorbidities", and "beta blockers in heart failure".
RESULT: It was found that an all HFpEF trials for new pharmacological agents like SGLT2I, ARNI, MRA and nsMRA, beta blocker therapy had been there during screening in 80-90% of patients with HFpEF. Neither the reasons were explored nor the Beta blockers were withdrawn for inclusion in the studies.
CONCLUSION: Current evidence suggests that beta-blockers can be prescribed based on comorbidity profiles rather than as HFpEF specific therapy. Well-designed randomized studies particularly those incorporating phenotype-based patient selection are needed to clarify the therapeutic role of beta-blockers.