Skill Checkup: A Woman With Long‐standing Hypertension and Worsening Dyspnea on Exertion

Yasmine S. Ali, MD


December 23, 2021

A clinical trial published in October 2021 found that empagliflozin — a sodium-glucose cotransporter 2 (SGLT2) inhibitor — reduced the combined risk for cardiovascular death or HF-related hospitalization in patients with HFpEF, regardless of the presence or absence of diabetes. This comes on the heels of evidence showing that SGLT2 inhibitors reduce the risk for HF-associated hospitalization or death in patients with HFrEF. Loop diuretics have also been linked to reduced hospital readmission risk in the 30 days after an index hospitalization in patients who have HFpEF, according to a study published in 2020. However, loop diuretics have not been shown to reduce mortality in either HFrEF or HFpEF.

In patients with HFrEF, combinations of drug therapies that may include angiotensin-converting enzyme (ACE) inhibitors; angiotensin receptor/neprilysin inhibitors (ARNIs), such as sacubitril-valsartan; beta-blockers; ivabradine; and mineralocorticoid receptor antagonists provide incremental benefit, with marked reductions in all-cause mortality, cardiovascular mortality, all-cause hospitalizations, and hospitalizations for HF.


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