Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps.
G, M., C, F., G, G., K, M., K, D., K, A., C, C., K, S., & K, T. (2026). Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62071222
G M, C F, G G, K M, K D, K A, et al. Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps.. Medicina (Kaunas, Lithuania). 2026; doi: 10.3390/medicina62071222
G M, C F, G G, et al. Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps.[J]. Medicina (Kaunas, Lithuania). 2026. DOI: 10.3390/medicina62071222.
@article{g2026,
author = {Mavraganis G and Fragoulis C and Georgiopoulos G and Mavromoustakou K and Dimitriadis K and Aznaouridis K and Chrysohoou C and Stamatelopoulos K and Tsioufis K},
title = {Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps.},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
doi = {10.3390/medicina62071222},
note = {PMID: 42512765},
}
TY - JOUR AU - Mavraganis G AU - Fragoulis C AU - Georgiopoulos G AU - Mavromoustakou K AU - Dimitriadis K AU - Aznaouridis K AU - Chrysohoou C AU - Stamatelopoulos K AU - Tsioufis K TI - Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps. T2 - Medicina (Kaunas, Lithuania) PY - 2026 DO - 10.3390/medicina62071222 AN - PMID:42512765 ER -
Hypertension is among the most important modifiable risk factors associated with heart failure with preserved ejection fraction (HFpEF) development and progression, yet guideline-directed blood pressure (BP) targets (<130/80 mmHg) and sodium-glucose co-transporter 2 inhibitor (SGLT2i) therapies lack dedicated randomized controlled trials (RCTs) in this specific group of patients. This narrative review synthesizes 2024 ESC/ESH and 2025 JSH meta-analyses, discussing the proposed pathophysiological framework linking hypertension-associated remodeling with HFpEF. Post hoc analyses from landmark trials (EMPEROR-Preserved, DELIVER) demonstrate consistent heart failure (HF) event reductions with SGLT2i (pooled HR 0.79, 95% CI 0.67-0.93), complemented by modest systolic BP lowering (-2.3 mmHg) and biomarker insights. Soluble ST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) may contribute to risk stratification in HFpEF populations when interpreted in conjuction with imaging findings and clinical context; however, neither biomarker is specific for hypertension-mediated remodeling. Critical evidence gaps persist: heterogeneous BP thresholds across international guidelines, limited device therapy data (renal denervation showing -8.5 mmHg sustained reduction), and real-world implementation barriers among elderly/comorbid Europeans (adherence < 50%, polypharmacy risks). Hellenic HF Registry data highlight frailty prevalence (68% in patients > 75 years) complicating aggressive BP management. The review addresses phenotype-specific challenges through precision medicine approaches incorporating phenomapping and multi-biomarker panels (NRI 0.28 improvement). We advocate for dedicated HFpEF RCTs evaluating intensive vs. standard BP targets, SGLT2i sequencing with antihypertensives, and European real-world registries to bridge the translational gap. These strategies aim to transform guideline recommendations into optimized, patient-centered care for the rapidly expanding hypertensive HFpEF population.