Epidemiology and clinical characteristics of heart failure with preserved ejection fraction in hypertensive patients over 60 years old: preliminary results from epidemiology and cli-hypertension
M Marketou, E K Kalistratos, D K Konstantinidis, H T Triantafillidi, C G Grassos, S M Maragkoudakis, J K Kopidakis, I B Bostanitis, E S Sanidas, J Z Zarifis, V K Katsi, C T Thomopoulos, D P Papadopoulos, M D Divani, C T TsioufisAbstract
Background
Heart failure with preserved ejection fraction (HFpEF) is highly prevalent among older hypertensive patients and is associated with substantial morbidity and mortality, yet it remains frequently underdiagnosed and suboptimally treated in routine practice.
Purpose
To evaluate the prevalence, diagnostic approach and pharmacological management of HFpEF in specialised hypertension outpatient clinics across Greece, and to identify key gaps in quality of care.
Methods
We conducted a multicentre cross-sectional survey in 10 specialised hypertension centres between November 2023 and January 2025, enrolling 1,017 consecutive hypertensive outpatients aged ≥60 years. Data were collected from structured interviews, clinical examination, laboratory tests and echocardiography. We compared clinical characteristics, comorbidities and treatments between patients with and without HFpEF and calculated H2FPEF scores where complete data were available.
Results
HFpEF prevalence was 35.2% (358/1,017). Patients with HFpEF were older (78.3 vs 71.6 years, p<0.001), more often female (58.5% vs 48.8%, p=0.004) and had higher rates of diabetes (52.2% vs 30.4%, p<0.001), chronic kidney disease (45.5% vs 11.5%, p<0.0001) and coronary artery disease (17.6% vs 8.4%, p<0.0001) than non-HFpEF patients. Despite suggestive symptoms and echocardiographic findings, only 48% of HFpEF cases had a documented diagnosis in the medical records. Use of SGLT2 inhibitors was high (56.4%), whereas mineralocorticoid receptor antagonists (MRAs) were prescribed in only 36.3% of HFpEF patients. In the subgroup with complete data (n=225), an H2FPEF score ≥6 identified HFpEF with a prevalence of 90.1%, while lowering the threshold to ≥5 yielded sensitivity 70.2% and specificity 79.3%. Blood pressure control was adequate in most patients at the conventional threshold: among those with available measurements, 69.9% had BP <140/90 mmHg, while 30.1% remained above this level. Using the stricter 130/80 mmHg criterion, only 55.1% were below target, and 44.9% had BP ≥130/80 mmHg.HFpEF patients showed significantly higher hospitalization rates than non-HF patients, with 27 .4% of HF cases hospitalized ≥1 time last year versus 3.6% without HF (risk ratio 7.52).
Conclusions
In specialised Greek hypertension clinics, HFpEF is common but frequently underrecognised, with important gaps in diagnostic work-up and use of evidence-based therapies, particularly MRAs. High uptake of SGLT2 inhibitors suggests growing adherence to recent ESC recommendations, while our data support the po tential value of systematic use of the H2FPEF score to improve HFpEF detection in older hypertensive populations.