Heart failure is a serious health problem in the United States, affecting millions of people and placing a heavy burden on the healthcare system.
It happens when the heart can’t pump blood well enough to meet the body’s needs.
People with heart failure often feel tired, short of breath, and may have swelling in their legs or belly due to fluid build-up.
In many cases, heart failure is caused by a weak heart muscle that struggles to pump blood. But about half of patients have a different type—one where the heart’s pumping strength is normal, but it becomes stiff and can’t relax properly.
This type is known as “stiff heart” heart failure, or more formally, heart failure with preserved ejection fraction (HFpEF). It’s common in older adults, especially women, and is often harder to treat.
A new study from the University of Vermont is raising questions about a popular group of medications called beta-blockers, which are widely used in heart patients.
Beta-blockers help by slowing the heart rate and lowering blood pressure, reducing the workload on the heart. They are a standard, life-saving treatment for patients with “weak heart” failure—where the heart’s pumping ability is reduced.
But for people with “stiff heart” failure, the benefits of beta-blockers are unclear. Since the heart’s pumping function is preserved in these patients, the problem lies in the heart’s ability to relax and fill with blood. The University of Vermont researchers wanted to find out whether beta-blockers help or harm these patients.
To investigate, the research team looked at data from a large clinical trial called TOPCAT, which included people with “stiff heart” failure. Around 80% of participants in the trial were taking beta-blockers.
The researchers, led by Dr. Timothy Plante, found that people using beta-blockers had a 74% higher risk of being hospitalized for heart failure compared to those not taking them.
The study suggests that, in “stiff heart” heart failure, beta-blockers might actually make things worse. Because the heart is already having trouble relaxing, slowing it down with beta-blockers may cause pressure to build up in the heart and lungs. This can lead to more fluid retention and make breathing more difficult—exactly the kind of symptoms these patients are trying to avoid.
What makes this finding especially concerning is that beta-blockers are commonly prescribed to patients with all types of heart failure. Yet they have not been well studied in “stiff heart” cases. This means doctors may be giving patients a medication that doesn’t help—and could even cause harm—simply because it works well for a different kind of heart problem.
The takeaway from this research is that heart failure is not a one-size-fits-all condition. Just because two people have similar symptoms doesn’t mean they should get the same treatment. For patients with “stiff heart” failure, it’s important to have open conversations with their doctors about whether beta-blockers are truly the right choice.
Doctors and researchers agree that more studies are needed to better understand how to treat this type of heart failure. Right now, there are few proven medications for it, and treatment decisions are often based on experience rather than strong evidence.
This study, published in JAMA Network Open, highlights the need for more personalized care in heart failure. It’s a reminder that good intentions—even with trusted medications—can have unintended consequences if we don’t take the time to understand each patient’s unique condition.
If you care about high blood pressure, please read studies that early time-restricted eating could help improve blood pressure, and natural coconut sugar could help reduce blood pressure and artery stiffness.
For more information about blood pressure, please see recent studies about added sugar in your diet linked to higher blood pressure, and results showing vitamin D could improve blood pressure in people with diabetes.
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