Neurohumoral pathways in heart failure with preserved systolic function.

Other than natriuretic peptides, neurohumoral markers have not been studied adequately in heart failure with preserved systolic function. There is little evidence of chronic activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, as in heart failure with reduced systolic function. These and other neurohumoral pathways may, however, become excessively stimulated by exercise and during episodes of acute decompensation. Blood natriuretic peptide concentrations are chronically elevated in patients with heart failure and preserved systolic function but not to the same extent as in patients with reduced systolic function. The role of neurohumoral antagonists in the treatment of heart failure and preserved systolic function has yet to be fully investigated.