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Cohort study
Lack of definitive evidence for the use of renin-angiotensin system antagonists for heart failure with preserved ejection fraction
  1. Umair Khalid1,
  2. Anita Deswal1,2
  1. 1Department of Medicine, Baylor College of Medicine, Houston, TX, USA
  2. 2Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
  1. Correspondence to: Dr Anita Deswal
    Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, 111 B, 2002 Holcombe Boulevard, Houston, TX 77030, USA; adeswal{at}bcm.tmc.edu

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Commentary on Lund LH, Benson L, Dahlström U, et al. Association between use of renin-angiotensin system antagonists and mortality in patients with heart failure and preserved ejection fraction. JAMA 2012;308:2108–17.

Context

Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for approximately half of all patients with HF in the community.1 The condition is associated with substantial morbidity and mortality, yet no medications have been proven to reduce mortality in these patients. Debate continues about HFpEF and HF with reduced ejection fraction (HFrEF) representing overlapping or distinct phenotypes within the HF spectrum.2 ,3 The benefit of renin-angiotensin system (RAS) antagonists including ACE inhibitors (ACEI) and angiotensin receptor blockers (ARBs) is well established in reducing mortality and morbidity in HFrEF. Although RAS activation is implicated in the pathophysiology of HFpEF, …

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