In HFpEF, which therapy is not associated with proven mortality benefit?

• A. RAAS inhibitors
• B. Diuretics
• C. Beta-blockers
• D. Statins

Answer: (A)

In HFpEF the goal isn’t driven by mortality reduction the way it is in HFrEF; many therapies that help with symptoms or risk factors don’t have proven to extend survival in HFpEF. Angiotensin pathway blockers—ACE inhibitors or ARBs—have not shown a clear mortality benefit in this group. Large randomized trials, such as I-PRESERVE with losartan and PARAGON-HF with sacubitril/valsartan, did not demonstrate a reduction in death or in the composite of death and heart failure hospitalization. By contrast, diuretics are used to relieve fluid overload and improve symptoms, which is crucial in HFpEF, but they don’t improve survival. Beta-blockers and statins may be used for comorbid conditions or symptom management, but they also lack consistent mortality benefit evidence specifically for HFpEF. Therefore, RAAS inhibitors are the therapy not associated with proven mortality benefit in HFpEF.