What is listed as a secondary therapy for HFpEF?

• A. Diuretics
• B. SGLT2 inhibitors
• C. MRAs
• D. ARNi/ACEi/ARBs/BB

Answer: (D)

In HFpEF, the main goal is to relieve symptoms while also managing blood pressure and other conditions that worsen the heart’s function. Diuretics are the go-to for fluid overload and edema, providing quick symptom relief. But for longer-term management beyond this, therapies that modulate the neurohormonal systems driving heart failure are used as secondary therapy. This includes a combination approach with agents that block the renin-angiotensin-aldosterone system (such as ARNi, ACE inhibitors, or ARBs) along with beta-blockers. These drugs help reduce strain on the heart, control heart rate, and address hypertension and other comorbidities that contribute to the HFpEF syndrome. While they don’t have as strong mortality data in HFpEF as in HFrEF, they are still a cornerstone of secondary management in appropriate patients, which is why this option is considered the best choice among the listed therapies.

Diuretics relieve congestion but don’t modify disease progression, so they’re viewed as symptomatic, not a secondary disease-modifying strategy. SGLT2 inhibitors are now widely recommended for HFpEF and would also be part of modern management, and MRAs can be helpful in select patients, but the broad neurohormonal blockade combo represents the classic secondary therapy approach in this context.