Managing Heart Failure with Preserved Systolic Function: Another Disappointment

The search for an efficacious treatment for patients with heart failure and normal or near-normal LV systolic function has failed to yield any positive results. To test whether irbesartan, an angiotensin-receptor blocker, reduces mortality and cardiovascular morbidity in this population, investigators conducted the industry-sponsored, international Irbesartan in Heart Failure with Preserved Ejection Fraction Study (I-PRESERVE). They enrolled 4128 patients aged ≥60 who had heart failure and an LV ejection fraction of ≥45%. After a placebo run-in period, participants were randomized to receive irbesartan or placebo. The dose was initially 75 mg daily and was gradually increased to 300 mg daily as tolerated. The primary outcome was time to the…