Heart Failure with Preserved Ejection Fraction: a Pharmacotherapeutic Update

Abstract

While guidelines for management of heart failure with reduced ejection fraction (HFrEF) are consensual and have led to improved survival, treatment options for heart failure with preserved ejection fraction (HFpEF) remain limited and aim primarily for symptom relief and improvement of quality of life. Due to the shortage of therapeutic options, several drugs have been investigated in multiple clinical trials. The majority of these trials have reported disappointing results and have suggested that HFpEF might not be as simply described by ejection fraction as previously though. In fact, HFpEF is a complex clinical syndrome with various comorbidities and overlapping distinct phenotypes that could benefit from personalized therapeutic approaches. This review summarizes the results from the most recent phase III clinical trials for HFpEF and the most promising drugs arising from phase II trials as well as the various challenges that are currently holding back the development of new pharmacotherapeutic options for these patients.

Promising directions in the treatment of chronic heart failure: improving old or developing new ones?

“…Потенциал развития обсуждаемого направления патогенетической терапии ХСН не является исчерпанным. В частности, известная роль накапливающегося в задней доле гипофиза (нейрогипофиз) пептидного гормона гипоталамуса вазопрессина (антидиуретический гормон) в механизмах задержки жидкости, а также ремоделирования и дисфункции сердца и сосудов у пациентов с ХСН, позволяет рассматривать последний в качестве мишени фармакологического вмешательства [53,54]. Так называемые акваретики (ваптаны) с успехом применяются у пациентов с ХСН, ассоциированной с выраженной гиперволемической гипонатриемией [1].…”

Preclinical study for the ameliorating effect of l-ascorbic acid for the oxidative stress of chronic administration of organic nitrates on myocardial tissue in high sucrose/fat rat model

“…NO metabolism mainly occurs in the RBCs ( Graham et al, 2021 , Vaz-Salvador et al,2022 ). Besides, NO bioactivity is preserved by RBCs.…”