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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • 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


  • 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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