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Advances in the pharmacotherapy of chronic heart failure with preserved ejection fraction: an ideal opportunity for precision medicine.

Abstract Heart failure with preserved ejection fraction (HFpEF), which comprises approximately 50% of all heart failure patients, is a challenging and complex clinical syndrome that is often thought to lack effective treatments. Areas covered: Despite the common mantra that HFpEF has no effective treatments, closer inspection of HFpEF clinical trials reveals that several of the drugs tested are associated with benefits in exercise capacity and quality of life, and reduction in heart failure hospitalization. Here we review major randomized controlled trials in HFpEF, focusing on renin-angiotensin-aldosterone system antagonists, organic nitrates, digoxin, beta-blockers, and phosphodiesterase-5 inhibitors. In addition, we review several classes of drugs currently in development for HFpEF such as neprilysin inhibitors, inorganic nitrates (nitrites), and soluble guanylate cyclase stimulators. Expert opinion: HFpEF should not be viewed as lacking effective treatments. While there have been no breakthrough clinical trials, several existing medications are likely to benefit specific subgroups of HFpEF patients. HFpEF is now well known to be a heterogeneous syndrome; thus, the clinical management of HFpEF patients and future HFpEF clinical trials will both likely require a nuanced, phenotype-specific approach instead of a one-size-fits-all tactic. Drug development for HFpEF therefore represents an exciting opportunity for personalized medicine.
PMID
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Authors

Mayor MeshTerms
Keywords

clinical trials

heart failure with preserved ejection fraction

pharmacotherapy

phenotype

Journal Title expert opinion on pharmacotherapy
Publication Year Start




PMID- 28129699
OWN - NLM
STAT- Publisher
DA  - 20170128
LR  - 20170128
IS  - 1744-7666 (Electronic)
IS  - 1465-6566 (Linking)
DP  - 2017 Jan 27
TI  - Advances in the pharmacotherapy of chronic heart failure with preserved ejection 
      fraction: an ideal opportunity for precision medicine.
LID - 10.1080/14656566.2017.1288717 [doi]
AB  - INTRODUCTION: Heart failure with preserved ejection fraction (HFpEF), which
      comprises approximately 50% of all heart failure patients, is a challenging and
      complex clinical syndrome that is often thought to lack effective treatments.
      Areas covered: Despite the common mantra that HFpEF has no effective treatments, 
      closer inspection of HFpEF clinical trials reveals that several of the drugs
      tested are associated with benefits in exercise capacity and quality of life, and
      reduction in heart failure hospitalization. Here we review major randomized
      controlled trials in HFpEF, focusing on renin-angiotensin-aldosterone system
      antagonists, organic nitrates, digoxin, beta-blockers, and phosphodiesterase-5
      inhibitors. In addition, we review several classes of drugs currently in
      development for HFpEF such as neprilysin inhibitors, inorganic nitrates
      (nitrites), and soluble guanylate cyclase stimulators. Expert opinion: HFpEF
      should not be viewed as lacking effective treatments. While there have been no
      breakthrough clinical trials, several existing medications are likely to benefit 
      specific subgroups of HFpEF patients. HFpEF is now well known to be a
      heterogeneous syndrome; thus, the clinical management of HFpEF patients and
      future HFpEF clinical trials will both likely require a nuanced,
      phenotype-specific approach instead of a one-size-fits-all tactic. Drug
      development for HFpEF therefore represents an exciting opportunity for
      personalized medicine.
FAU - Polsinelli, Vincenzo B
AU  - Polsinelli VB
AD  - a Division of Cardiology, Department of Medicine , Northwestern University
      Feinberg School of Medicine , Chicago , Illinois.
FAU - Shah, Sanjiv J
AU  - Shah SJ
AD  - a Division of Cardiology, Department of Medicine , Northwestern University
      Feinberg School of Medicine , Chicago , Illinois.
LA  - eng
PT  - Journal Article
DEP - 20170127
PL  - England
TA  - Expert Opin Pharmacother
JT  - Expert opinion on pharmacotherapy
JID - 100897346
OTO - NOTNLM
OT  - clinical trials
OT  - heart failure with preserved ejection fraction
OT  - pharmacotherapy
OT  - phenotype
EDAT- 2017/01/29 06:00
MHDA- 2017/01/29 06:00
CRDT- 2017/01/29 06:00
AID - 10.1080/14656566.2017.1288717 [doi]
PST - aheadofprint
SO  - Expert Opin Pharmacother. 2017 Jan 27. doi: 10.1080/14656566.2017.1288717.

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