Potential effects of beta-blockers in HFpEF

Heart failure with preserved ejection fraction (HFpEF) poses a significant challenge in contemporary medicine, characterized by poor quality of life, high healthcare costs, and increased mortality. Despite advancements in medical research, treatment strategies for HFpEF remain elusive, with unclear guidance on the use of beta-blockers. While sympathetic overstimulation is common in HFpEF, beta-blockers, though potentially beneficial in reducing sympathetic activity, may exacerbate chronotropic incompetence and decrease exercise tolerance. Additionally, their impact on outcomes in HFpEF patients with concurrent atrial fibrillation is uncertain. Some studies suggest the potential benefits of beta-blockers on diastolic function, yet evidence on clinical endpoints remains inconclusive. Recent research indicates a potential reduction in all-cause mortality with beta-blocker use in HFpEF, although their effect on combined mortality or HF hospitalizations is less clear. Moreover, beta-blocker efficacy may vary depending on ejection fraction subgroups, with more favorable outcomes observed in HFmrEF compared to HFpEF. Current literature underscores the need for large-scale randomized clinical trials to clarify the role of beta-blockers in HFpEF management. Given the limitations of existing evidence, future research is essential to inform updated treatment guidelines and therapeutic protocols tailored to the contemporary clinical landscape.