treatment of diastolic heart failure (DHF) (heart failure with preserved left ventricular systolic ejection fraction (HFPEF)) is unsatisfactory
systolic hypertension should be treated to achieve adequate blood pressure control (1)
when fluid retention is present diuretics (frusemide or thiazide) have been shown to improve symptoms (1)
if the diagnosis has been made, patients can be started on low to medium dose of loop diuretics e.g. - less than 80mg of furosemide per day (2)
coronary revascularisation should be considered if there is evidence of reversible myocardial ischaemia
angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been shown to improve symptoms and quality of life in patients with DHF, but do not reduce mortality (1)
aldosterone antagonists reduce cardiac fibrosis and are also effective anti-hypertensives (1)
advice on life-style and dietary changes given to patients with systolic heart failure (e.g. low salt intake) may also be helpful for patients with DHF
Notes:
in the management of HFPEF treatment of comorbid conditions such as hypertension, myocardial ischemia and diabetes mellitus is thought to be important (2,3)
patients who do not respond to loop diuretics should be referred to a specialist for further management (2).
verapamil in HFPEF
two very small studies with less than 30 patients in each have shown that verapamil is helpful in improving exercise capacity and symptoms in HFPEF patients (3)
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