Vidal-Perez R, Vazquez-Rodriguez JM. Letter to the Editor: Beta-blockers vs calcium channel blockers in heart failure with preserved ejection fraction: An old question in need of new answers. World J Cardiol 2026; 18(6): 117807 [DOI: 10.4330/wjc.117807]
Corresponding Author of This Article
Rafael Vidal-Perez, Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, As Xubias de Arriba-84, A Coruña 15006, Galicia, Spain. rafavidal@hotmail.com
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Cardiac & Cardiovascular Systems
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letter
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Vidal-Perez R, Vazquez-Rodriguez JM. Letter to the Editor: Beta-blockers vs calcium channel blockers in heart failure with preserved ejection fraction: An old question in need of new answers. World J Cardiol 2026; 18(6): 117807 [DOI: 10.4330/wjc.117807]
World J Cardiol. Jun 26, 2026; 18(6): 117807 Published online Jun 26, 2026. doi: 10.4330/wjc.117807
Letter to the Editor: Beta-blockers vs calcium channel blockers in heart failure with preserved ejection fraction: An old question in need of new answers
Rafael Vidal-Perez, Jose Manuel Vazquez-Rodriguez
Rafael Vidal-Perez, Jose Manuel Vazquez-Rodriguez, Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Galicia, Spain
Author contributions: Vidal-Perez R designed, performed the collection of the data, edited, and wrote the paper; Vazquez-Rodriguez JM contributed to the critical revision and editing of the paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Rafael Vidal-Perez, Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, As Xubias de Arriba-84, A Coruña 15006, Galicia, Spain. rafavidal@hotmail.com
Received: December 16, 2025 Revised: January 12, 2026 Accepted: March 5, 2026 Published online: June 26, 2026 Processing time: 184 Days and 10.8 Hours
Abstract
Heart failure with preserved ejection fraction (HFpEF) remains a complex and heterogeneous syndrome without robust disease-modifying therapies. In this context, the retrospective analysis comparing beta-blockers and calcium channel blockers offers intriguing signals that beta-blockers may reduce all-cause mortality and heart failure hospitalizations, albeit at the expense of increased symptomatic bradycardia and treatment discontinuation. While these findings are not definitive, they highlight the potential relevance of heart-rate control and autonomic modulation in selected HFpEF phenotypes. This article discusses the clinical implications and limitations of the study by Mansoor et al published in World Journal of Cardiology, emphasizing the need for precision-based treatment strategies and calling for prospective trials to clarify the true prognostic impact of beta-blockers in HFpEF. Ultimately, the study reinforces the notion that therapeutic decisions in HFpEF must be individualized, integrating hemodynamic, rhythm-related, and comorbidity-driven considerations.
Core Tip: Heart failure with preserved ejection fraction (HFpEF) remains a heterogeneous syndrome lacking robust disease-modifying therapies. This article critically examines the long-standing debate between beta-blockers and calcium channel blockers in HFpEF, integrating evidence from meta-analyses, observational studies, and a recent retrospective comparison. While beta-blockers may confer modest benefits in selected phenotypes - particularly in patients with atrial fibrillation or coronary artery disease - their potential to worsen chronotropic incompetence limits universal applicability. Calcium channel blockers appear largely safe and may reduce hospitalizations in specific settings. Overall, the analysis underscores the need for phenotype-driven, individualized treatment strategies and prospective trials to guide therapy in HFpEF.
