Hormonal
Therapeutic reduction of central adiposity via bariatric surgery or incretin-based drugs significantly reduces the risk of heart failure hospitalizations and worsening heart failure events in patients with HFpEF, whereas blood pressure lowering alone yields only modest benefits unrelated to the magnitude of BP reduction.
For HFpEF patients, focusing solely on blood pressure medication is insufficient. Prioritizing significant weight loss through bariatric surgery or incretin-based medications (like semaglutide or tirzepatide) is critical, as these interventions directly reduce the hormonal and mechanical drivers of heart failure, leading to a 50-60% reduction in worsening heart failure events.
Therapeutic amelioration of excess adiposity by bariatric surgery or incretin-based drugs appears to have substantial effects on the evolution and progression of HFpEF, with reported reductions of 40% to 60% in the risk of heart failure hospitalizations.
Why this rating
Based on large observational studies, Mendelian randomization, and multiple RCTs (though BP trials were not HFpEF-specific, weight loss trials were).
Source
Central Adiposity or Hypertension
Milton Packer et al. · Journal of the American College of Cardiology · 2025
DOI 10.1016/j.jacc.2025.08.036
Related findings · Hormonal
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