beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction (HFpEF)

Last edited 12/2021 and last reviewed 01/2022

Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction (HFpEF)

• a Cochrane review (41 RCTs, n=23,492) found moderate certainty evidence that mineralocorticoid receptor antagonists (MRA) and angiotensin receptor neprilysin inhibitors (ARNI) may reduce heart failure hospitalisation, but probably have little or no effect on cardiovascular mortality and quality of life
  
  
  • evidence that MRA and ARNI treatment in HFpEF probably reduces heart failure hospitalisation but probably has little or no effect on cardiovascular mortality and quality of life
    
    
  •  BB (beta blockers) treatment may reduce the risk of cardiovascular mortality, however, further trials are needed
    
    
  • current evidence for BBs, ACEIs (ACE inhibitors), and ARBs (angiotensin recetptor blockers) is limited and does not support their use in HFpEF in the absence of an alternative indication
    
    
  • although MRAs and ARNIs are probably effective at reducing the risk of heart failure hospitalisation, the treatment effect sizes are modest

Reference:

• Martin N, Manoharan K, Davies C, Lumbers RT. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database of Systematic Reviews 2021, Issue 5. Art. No.: CD012721. DOI: 10.1002/14651858.CD012721.pub3