HFpEF management in current guidelines is best described by which statement?

• A. Treat comorbidities and BP control; GDMT mortality benefit is limited
• B. Only use diuretics; ignore comorbidities
• C. ACE inhibitors provide clear mortality benefit in all HFpEF
• D. Avoid exercise

Answer: (A)

Focusing on comorbidity management and blood pressure control is what HFpEF care centers on because the problems driving this condition are often systemic—hypertension, obesity, diabetes, and atrial fibrillation—rather than a single heart‑muscle deficiency. Controlling BP helps limit ongoing stiffening and remodeling of the left ventricle, which in turn can improve symptoms and reduce hospitalizations. Diuretics are useful for relieving congestion and short‑term symptoms, but they don’t change the disease course. In contrast, the classic disease‑modifying drugs proven to reduce mortality in HFrEF haven’t shown a clear mortality benefit across HFpEF populations, so the overall mortality benefit of GDMT is limited in HFpEF. Guideline‑level care, therefore, emphasizes treating comorbidities, optimizing BP, and promoting exercise and risk‑factor modification, with diuretics for symptom relief and consideration of newer therapies as evidence evolves. The other statements misstate the evidence—relying only on diuretics ignores driving factors, claiming a universal mortality benefit from ACE inhibitors is not supported, and advising against exercise contradicts guidelines that favor activity to improve function.