Common blood pressure medications may worsen “stiff heart” failure, researchers say

Heart failure is a major and growing health issue in the United States. It affects millions of people and drives billions of dollars in healthcare spending each year. What many people do not realize is that there is more than one type of heart failure, and a treatment that helps one form may be risky for another.

Key Takeaways

“Stiff heart” heart failure, also known as HFpEF, is about as common as “weak heart” failure, but it is less widely understood.
A University of Vermont study found that beta-blockers, a commonly used heart failure drug, may worsen symptoms for many people with HFpEF.
Patients taking beta-blockers for this form of heart failure were 74% more likely to be hospitalized for heart failure.
Doctors and patients should discuss medication choices carefully, especially for HFpEF.

The Two Faces of Heart Failure

Most people picture heart failure as a condition in which the heart is too weak to pump blood effectively. But there is another, less familiar type called “stiff heart” heart failure, or HFpEF, in which the heart still pumps normally but does not relax well enough to fill properly. This type is just as common as the traditional “weak heart” form, yet it often receives less attention and calls for a different treatment strategy.

Beta-Blockers: Helpful or Harmful?

Beta-blockers are widely used for many heart conditions. For patients with “weak heart” failure, they can be lifesaving because they reduce symptoms, hospitalizations, and the risk of early death. For HFpEF, however, the evidence is much less certain. Because there are few proven medications for “stiff heart” failure, doctors often turn to beta-blockers even though their benefits in this group are not clearly established.

What the Study Found

Researchers at the University of Vermont examined how beta-blockers affect people with HFpEF. Using data from a large clinical trial known as TOPCAT, they found that patients taking beta-blockers were 74% more likely to be hospitalized for heart failure than those who were not using the medication. The results suggest the treatment may not only fail to help some patients, but could also make their condition worse.

Why the Drug May Backfire

Unlike in “weak heart” failure, where beta-blockers reduce the heart’s workload, these drugs may raise pressure inside the heart in HFpEF. That can intensify symptoms such as fluid retention and shortness of breath, both of which are already common problems for people with this condition. The findings point to the limits of a one-size-fits-all approach to heart failure treatment.

What Patients Should Ask

If you or a loved one has been diagnosed with “stiff heart” failure, it is important to talk with a doctor about which medications are being used and why. Patients should ask whether their treatment plan is supported by strong evidence for their specific condition. Care should be tailored to the individual, based on the latest research.

Why the Research Matters

Led by Dr. Timothy Plante, the study’s authors say their work highlights the need for more research and better treatment options for HFpEF. People with this type of heart failure currently have fewer proven choices, and further studies may help lead to safer and more effective care.

Bottom Line

The question of whether beta-blockers should be used in “stiff heart” heart failure is still unresolved, but this study could influence how doctors approach the condition. For patients and families living with heart failure, staying in close contact with healthcare providers remains one of the best ways to support safer and more effective treatment.

Scientific References

Plante, T.B., et al. (2024). “Beta-Blocker Use in Heart Failure With Preserved Ejection Fraction: Findings From TOPCAT.” JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816789
American Heart Association – What is Heart Failure? https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure