Current Treatment of Heart Failure with Preserved Ejection Fraction
Mauro Riccardi, Emilia D’Elia, Carlo Lombardi, Gianluigi Savarese, Mauro Gori, Fabrizio Oliva, Maurizio Volterrani, Michele Senni, Marco Metra, Riccardo M. Inciardi
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with increasing prevalence and substantial morbidity and mortality. Recent advances in pharmacotherapy have transformed its management. This review summarizes current evidence supporting the use of sodium-glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, alongside selected use of angiotensin receptor-neprilysin inhibitors. Emphasis is placed on early initiation of disease-modifying therapies, phenotypic tailoring, and comorbidity-targeted strategies, especially in obese and diabetic patients. Together, these approaches define a new era of guideline-directed, personalized care for patients with HFpEF.