Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Curr Hypertens Rep. 2024 Jul;26(7):291-306. doi: 10.1007/s11906-024-01296-2. Epub 2024 Apr 1.
To review the current evidence and modalities for treating pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF).
In recent years, several therapies have been developed that improve morbidity in HFpEF, though these studies have not specifically studied patients with PF-HFpEF. Multiple trials of therapies specifically targeting the pulmonary vasculature such as phosphodiesterase (PDE) inhibitors, prostacyclin analogs, endothelin receptor antagonists (ERA), and soluble guanylate cyclase stimulators have also been conducted. However, these therapies demonstrated lack of consistency in improving hemodynamics or functional outcomes in PH-HFpEF. There is limited evidence to support the use of pulmonary vasculature-targeting therapies in PH-HFpEF. The mainstay of therapy remains the treatment of the underlying HFpEF condition. There is emerging evidence that newer HF therapies such as sodium-glucose transporter 2 inhibitors and angiotensin-receptor-neprilysin inhibitors are associated with improved hemodynamics and quality of life of patients with PH-HFpEF. There is also a growing realization that more robust phenotyping PH and right ventricular (RV) function may hold promise for therapeutic strategies for patients with PH-HFpEF.
回顾目前治疗射血分数保留心力衰竭（HFpEF）合并肺动脉高压（PH）的证据和方法。
近年来，已经开发出多种改善 HFpEF 发病率的疗法，尽管这些研究并未专门研究 PF-HFpEF 患者。针对肺血管的多种靶向治疗药物的试验，如磷酸二酯酶（PDE）抑制剂、前列环素类似物、内皮素受体拮抗剂（ERA）和可溶性鸟苷酸环化酶刺激剂，也已经进行。然而，这些治疗方法在改善 PH-HFpEF 患者的血流动力学或功能结果方面缺乏一致性。有限的证据支持在 PH-HFpEF 中使用靶向肺血管的治疗方法。治疗的主要方法仍然是治疗潜在的 HFpEF 病症。有新出现的证据表明，新型 HF 治疗方法，如钠-葡萄糖转运蛋白 2 抑制剂和血管紧张素受体-脑啡肽酶抑制剂，与改善 PH-HFpEF 患者的血流动力学和生活质量相关。人们也越来越意识到，对 PH 和右心室（RV）功能进行更有力的表型分析可能为 PH-HFpEF 患者的治疗策略带来希望。
