Therapeutic Research

Abstract

As population aging advances, heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and incidence over 50％ of all heart failure presentations. Although the patients’ characteristics are different among regions and races, hypertension is a common background of the development of HFpEF in the world. In addition to aging and hypertension, obesity, diabetes mellitus, chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) are major comorbidities of HFpEF and affect endothelial dysfunction through increased oxidative stress, thereby develop diastolic dysfunction. To diagnose HFpEF, measurement of natriuretic peptides and identification of left ventricular diastolic dysfunction are mandatory because the symptoms of HFpEF are difficult to differentiate from those with CKD, COPD and obesity. Previous randomized clinical trials have failed to establish the effective pharmacological treatments for HFpEF, probably because of various pathological conditions. However, controlling blood pressure by anti-hypertensive agents and body fluid volume by diuretics is crucial for primary and secondary prevention of HFpEF.