What is the most significant cause of heart failure with preserved ejection fraction (HFpEF)?

Hypertension is recognized as the most significant cause of heart failure with preserved ejection fraction (HFpEF). This condition is characterized by the heart maintaining a normal ejection fraction while experiencing symptoms of heart failure due to various forms of diastolic dysfunction. Chronic high blood pressure leads to structural changes in the heart, such as left ventricular hypertrophy and stiffening, which impairs the heart's ability to fill properly during diastole. Over time, these adaptations can result in increased diastolic pressure and congestion, ultimately contributing to the development of HFpEF.

While other conditions such as ischemic heart disease, cardiomyopathy, and valvular heart disease can lead to heart failure, they typically correlate more with heart failure with reduced ejection fraction (HFrEF). In contrast, hypertension affects the heart's filling capacity without necessarily altering its pumping ability, making it the primary driver of HFpEF cases. As a result, managing blood pressure effectively is crucial in preventing and treating HFpEF. Understanding the underlying role of hypertension in this condition is vital for both prevention and management strategies within clinical settings.