In treating HFpEF, ACE inhibitors are considered for which group of patients?

In the treatment of heart failure with preserved ejection fraction (HFpEF), ACE inhibitors play a significant role for patients who present with symptomatic atherosclerotic disease or diabetes along with additional risk factors. This subset of patients tends to benefit from the neurohormonal modulation provided by ACE inhibitors, which can lead to improved outcomes by alleviating heart failure symptoms and potentially reducing hospitalizations.

Patients with symptomatic atherosclerotic disease or diabetes often already have a burden of comorbid conditions, and managing these alongside heart failure is crucial. The use of ACE inhibitors in these cases can help manage blood pressure, improve hemodynamics, and enhance overall cardiovascular health, which is particularly important given the interrelated nature of heart failure and other cardiovascular diseases.

The other groups mentioned may not exhibit the same level of benefit from ACE inhibitors, as they may lack the combination of symptomatic heart failure and significant underlying cardiovascular risks that necessitate the use of these medications.