Heart failure with preserved ejection fraction (HFPEF): exploring new therapeutic approaches.

Abstract

Heart failure with preserved ejection fraction (HFPEF) is a growing clinical challenge,
marked by high morbidity and mortality and scarce therapeutic options. In recent years,
sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially developed for diabetes
mellitus, have emerged as disease-modifying therapies across the entire spectrum of
heart failure. This narrative review aimed to analyze the application of SGLT2i in the
treatment of HFPEF, based on recent clinical trials, meta-analyses, and guidelines.
Evidence indicates that their benefits extend beyond glycemic control, encompassing
hemodynamic, renal, metabolic, and anti-inflammatory effects. Studies such as
EMPEROR-Preserved and DELIVER have demonstrated that empagliflozin and
dapagliflozin significantly reduce the risk of cardiovascular death and hospitalization for
heart failure, regardless of the presence of diabetes. Thus, SGLT2 inhibitors are
consolidating themselves as an essential pillar in the management of HFPEF, as
validated by international guidelines, although there is still the challenge of expanding
their clinical implementation to optimize patient outcomes.