{"id":"92cbe1082232","type":"article","url":"https://hartvaat.nl/2026/06/24/sglt2-remmers-en-bloeddrukdoelen-bij-hypertensief-hfpef-een-overzicht-van-richtl/","title":"SGLT2-remmers en bloeddrukdoelen bij hypertensief HFpEF — een overzicht van richtlijnen en bewijs","title_en":"Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Medicina (Kaunas, Lithuania)","doi":"10.3390/medicina62071222","source_url":"https://doi.org/10.3390/medicina62071222","authors":["Georgios Mavraganis","Christos Fragoulis","Georgios Georgiopoulos","Kyriaki Mavromoustakou","Kyriakos Dimitriadis","Konstantinos Aznaouridis","Christina Chrysohoou","Kimon Stamatelopoulos","Konstantinos Tsioufis"],"significance":5,"published":"2026-08-08","source_date":"2026-06-24","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/betablokkers-hypertensie/"],"congress":"","summary_en":"This narrative review evaluates current evidence for blood pressure targets (<130/80 mmHg) and SGLT2 inhibitor therapy in patients with hypertensive heart failure with preserved ejection fraction (HFpEF). Post-hoc analyses from EMPEROR-Preserved and DELIVER demonstrate consistent reductions in heart failure events with SGLT2 inhibitors (pooled HR 0.79), alongside modest systolic blood pressure lowering. While biomarkers such as sST2 and NT-proBNP aid risk stratification, significant evidence gaps remain regarding guideline harmonisation, device therapies like renal denervation, and real-world adherence. The review underscores the need for phenotype-driven management and dedicated randomised trials to translate current recommendations into routine clinical practice for this growing patient population.","created":"2026-08-01T01:16:53Z","updated":"2026-08-10T10:36:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narratieve review analyseert het huidige bewijs voor bloeddrukdoelen (<130/80 mmHg) en SGLT2-remmertherapie bij patiënten met hypertensief hartfalen met behouden ejectiefractie (HFpEF). Post-hoc analyses van EMPEROR-Preserved en DELIVER tonen een consistente reductie in HF-gebeurtenissen met SGLT2-remmers (pooled HR 0,79), gecombineerd met een bescheiden systolische bloeddrukverlaging. Hoewel biomarkers zoals sST2 en NT-proBNP nuttig zijn voor risicostratificatie, blijven er belangrijke bewijslacunes bestaan, waaronder heterogene richtlijnadviezen, beperkte data over nierdenervatie en lage adherentie in de praktijk. Voor cardiologen, huisartsen en internisten benadrukt het artikel de noodzaak van gepersonaliseerde aanpakken en dedicated RCTs om de vertaalslag van richtlijnen naar dagelijkse zorg te maken.","abstract_original":"Hypertension is among the most important modifiable risk factors associated with heart failure with preserved ejection fraction (HFpEF) development and progression, yet guideline-directed blood pressure (BP) targets (<130/80 mmHg) and sodium-glucose co-transporter 2 inhibitor (SGLT2i) therapies lack dedicated randomized controlled trials (RCTs) in this specific group of patients. This narrative review synthesizes 2024 ESC/ESH and 2025 JSH meta-analyses, discussing the proposed pathophysiological framework linking hypertension-associated remodeling with HFpEF. Post hoc analyses from landmark trials (EMPEROR-Preserved, DELIVER) demonstrate consistent heart failure (HF) event reductions with SGLT2i (pooled HR 0.79, 95% CI 0.67-0.93), complemented by modest systolic BP lowering (-2.3 mmHg) and biomarker insights. Soluble ST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) may contribute to risk stratification in HFpEF populations when interpreted in conjuction with imaging findings and clinical context; however, neither biomarker is specific for hypertension-mediated remodeling. Critical evidence gaps persist: heterogeneous BP thresholds across international guidelines, limited device therapy data (renal denervation showing -8.5 mmHg sustained reduction), and real-world implementation barriers among elderly/comorbid Europeans (adherence < 50%, polypharmacy risks). Hellenic HF Registry data highlight frailty prevalence (68% in patients > 75 years) complicating aggressive BP management. The review addresses phenotype-specific challenges through precision medicine approaches incorporating phenomapping and multi-biomarker panels (NRI 0.28 improvement). We advocate for dedicated HFpEF RCTs evaluating intensive vs. standard BP targets, SGLT2i sequencing with antihypertensives, and European real-world registries to bridge the translational gap. These strategies aim to transform guideline recommendations into optimized, patient-centered care for the rapidly expanding hypertensive HFpEF population."}