{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:48:46Z","timestamp":1793134126703,"version":"4.5.0"},"reference-count":87,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Obesity is prevalent among patients with heart failure (HF), especially in those with preserved ejection fraction (HFpEF), and complicates diagnosis, therapy, and monitoring. It alters haemodynamics, biomarker interpretation, and drug pharmacokinetics, potentially influencing treatment response. Evidence from subgroup analyses of major HF trials suggests that renin\u2013angiotensin system inhibitors (mainly sacubitril-valsartan), mineralocorticoid receptor antagonists, and sodium\u2013glucose cotransporter 2 inhibitors provide consistent benefits across body mass index (BMI) categories, with no major obesity-specific safety concerns. In contrast, data on beta-blockers in obese HF patients remains limited, largely reflecting the older design of pivotal trials. Management should include careful assessment of congestion, acknowledging the limitations of physical examination, and integrate natriuretic peptides measurement and imaging evaluation to guide individualised diuretic strategies. This expert consensus provides a comprehensive and pragmatic framework for the use of guideline-directed medical therapy in patients with HF and obesity, exploring the available evidence for each drug class and addressing efficacy, patient selection, safety, and monitoring.<\/jats:p>","DOI":"10.1093\/ejhf\/xuag027","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T12:39:08Z","timestamp":1769603948000},"page":"183-190","source":"Crossref","is-referenced-by-count":4,"title":["Implementation of guideline-directed medical therapy in patients with heart failure and obesity:\n                    <i>European Journal of Heart Failure<\/i>\n                    expert consensus document"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-943X","authenticated-orcid":false,"given":"Luca","family":"Monzo","sequence":"first","affiliation":[{"name":"CHRU de Nancy, Centre d\u2019Investigation Clinique Plurith\u00e9matique 1433, INSERM, Universit\u00e8 de Lorraine, INSERM U116-DCAC, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , 4 Rue du Morvan, 54511 Vand\u0153uvre-l\u00e8s-Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-0887","authenticated-orcid":false,"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset; Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9995-8590","authenticated-orcid":false,"given":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg A.V. , Genk ,","place":["Belgium"]},{"name":"Faculty of Medicine and Life Sciences, Hasselt University , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6701-7072","authenticated-orcid":false,"given":"Magdy","family":"Abdelhamid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kasr Al Ainy, Department of Cardiology, Cairo University , Giza ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena-Laura","family":"Antohi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Emergency Institute for Cardiovascular Diseases \u2018Prof. Dr. C.C. Iliescu\u2019 , Bucharest ,","place":["Romania"]},{"name":"University of Medicine and Pharmacy Carol Davila, Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pardeep S","family":"Jhund","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9613-5062","authenticated-orcid":false,"given":"Massimo","family":"Iacoviello","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia , Foggia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa A","family":"Jankowska","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroc\u0142aw Medical University , Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M Y","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7380-9877","authenticated-orcid":false,"given":"Felix","family":"Lindberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset; Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Platz","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, and Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6691-8568","authenticated-orcid":false,"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Clinical Cardiology Division, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3278-2057","authenticated-orcid":false,"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"CHRU de Nancy, Centre d\u2019Investigation Clinique Plurith\u00e9matique 1433, INSERM, Universit\u00e8 de Lorraine, INSERM U116-DCAC, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , 4 Rue du Morvan, 54511 Vand\u0153uvre-l\u00e8s-Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"2026100812221217500_xuag027-B1","doi-asserted-by":"publisher","first-page":"2372","DOI":"10.1093\/eurheartj\/ehaf057","article-title":"Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial","volume":"46","author":"Peikert","year":"2025","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B2","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1002\/ejhf.3676","article-title":"Heart failure and obesity: translational approaches and therapeutic perspectives. A scientific statement of the Heart Failure Association of the ESC","volume":"27","author":"Savarese","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B3","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1016\/j.jacc.2025.03.530","article-title":"Disentangling the impact of adiposity from insulin resistance in heart failure with preserved ejection fraction","volume":"85","author":"Reddy","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B4","doi-asserted-by":"publisher","first-page":"e396","DOI":"10.1016\/S2214-109X(23)00557-0","article-title":"Characteristics, management, and outcomes in women and men with congestive heart failure in 40 countries at different economic levels: an analysis from the Global Congestive Heart Failure (G-CHF) registry","volume":"12","author":"Walli-Attaei","year":"2024","journal-title":"Lancet Glob Health"},{"key":"2026100812221217500_xuag027-B5","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1016\/j.jacc.2025.06.055","article-title":"The adipokine hypothesis of heart failure with a preserved ejection fraction: a novel framework to explain pathogenesis and guide treatment","volume":"86","author":"Packer","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B6","doi-asserted-by":"publisher","first-page":"3434","DOI":"10.1093\/cvr\/cvac120","article-title":"Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets","volume":"118","author":"Borlaug","year":"2023","journal-title":"Cardiovasc Res"},{"key":"2026100812221217500_xuag027-B7","doi-asserted-by":"publisher","first-page":"115281","DOI":"10.1016\/j.biopha.2023.115281","article-title":"Pharmacokinetics of obese adults: not only an increase in weight","volume":"166","author":"Gouju","year":"2023","journal-title":"Biomed Pharmacother"},{"key":"2026100812221217500_xuag027-B8","doi-asserted-by":"publisher","first-page":"71","DOI":"10.2165\/11318100-000000000-00000","article-title":"Effect of obesity on the pharmacokinetics of drugs in humans","volume":"49","author":"Hanley","year":"2010","journal-title":"Clin Pharmacokinet"},{"key":"2026100812221217500_xuag027-B9","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B10","doi-asserted-by":"publisher","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B11","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.1002\/ejhf.70082","article-title":"Pharmacological treatment for patients with obesity and heart failure: focus on glucagon-like peptide-1 receptor agonists","volume":"27","author":"Monzo","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B12","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1093\/eurheartj\/ehaf645","article-title":"Do obesity and visceral adiposity promote heart failure with reduced ejection fraction?","volume":"47","author":"Packer","year":"2026","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B13","doi-asserted-by":"publisher","first-page":"2238","DOI":"10.1002\/ejhf.2741","article-title":"Connecting epicardial adipose tissue and heart failure with preserved ejection fraction: mechanisms, management and modern perspectives","volume":"24","author":"van Woerden","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B14","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1002\/ejhf.2709","article-title":"Association of epicardial adipose tissue with proteomics, coronary flow reserve, cardiac structure and function, and quality of life in heart failure with preserved ejection fraction: insights from the PROMIS-HFpEF study","volume":"24","author":"Venkateshvaran","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B15","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1038\/ijo.2013.203","article-title":"The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data","volume":"38","author":"Padwal","year":"2014","journal-title":"Int J Obes (Lond)"},{"key":"2026100812221217500_xuag027-B16","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1093\/eurheartj\/ehad083","article-title":"Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox","volume":"44","author":"Butt","year":"2023","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B17","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1016\/j.mayocp.2023.07.008","article-title":"Obesity, cardiorenal comorbidities, and risk of hospitalization in patients with heart failure with preserved ejection fraction","volume":"98","author":"Morgen","year":"2023","journal-title":"Mayo Clin Proc"},{"key":"2026100812221217500_xuag027-B18","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1016\/j.jacc.2016.11.081","article-title":"Relationship between physical activity, body mass index, and risk of heart failure","volume":"69","author":"Pandey","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B19","doi-asserted-by":"publisher","first-page":"6838","DOI":"10.3390\/ijms24076838","article-title":"The different pathways of epicardial adipose tissue across the heart failure phenotypes: from pathophysiology to therapeutic target","volume":"24","author":"Rossi","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2026100812221217500_xuag027-B20","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1002\/ejhf.2337","article-title":"Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure","volume":"23","author":"Pugliese","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B21","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1002\/ejhf.657","article-title":"Effect of liraglutide, a glucagon-like peptide-1 analogue, on left ventricular function in stable chronic heart failure patients with and without diabetes (LIVE)-a multicentre, double-blind, randomised, placebo-controlled trial","volume":"19","author":"Jorsal","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B22","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1111\/dom.14862","article-title":"Risk of adverse events with liraglutide in heart failure with reduced ejection fraction: a post hoc analysis of the FIGHT trial","volume":"25","author":"Neves","year":"2023","journal-title":"Diabetes Obes Metab"},{"key":"2026100812221217500_xuag027-B23","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/S0140-6736(24)01498-3","article-title":"Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial","volume":"404","author":"Deanfield","year":"2024","journal-title":"Lancet"},{"key":"2026100812221217500_xuag027-B24","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1586\/17446651.1.2.255","article-title":"Obesity and the renin-angiotensin-aldosterone system","volume":"1","author":"Sharma","year":"2006","journal-title":"Expert Rev Endocrinol Metab"},{"key":"2026100812221217500_xuag027-B25","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1016\/j.jchf.2018.01.009","article-title":"Obesity-related heart failure with a preserved ejection fraction: the mechanistic rationale for combining inhibitors of aldosterone, neprilysin, and sodium-glucose cotransporter-2","volume":"6","author":"Packer","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2026100812221217500_xuag027-B26","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1002\/ejhf.2795","article-title":"Use of and association between heart failure pharmacological treatments and outcomes in obese versus non-obese patients with heart failure with reduced ejection fraction: data from the Swedish Heart Failure Registry","volume":"25","author":"Cappelletto","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B27","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1093\/eurheartj\/ehx026","article-title":"Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study","volume":"38","author":"Ouwerkerk","year":"2017","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B28","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.jchf.2018.10.010","article-title":"Contemporary drug treatment of chronic heart failure with reduced ejection fraction: the CHECK-HF registry","volume":"7","author":"Brunner-La Rocca","year":"2019","journal-title":"JACC Heart Fail"},{"key":"2026100812221217500_xuag027-B29","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jacc.2018.04.070","article-title":"Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry","volume":"72","author":"Greene","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B30","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1016\/j.jacbts.2020.07.006","article-title":"Differential effects of sacubitril\/valsartan on diastolic function in mice with obesity-related metabolic heart disease","volume":"5","author":"Croteau","year":"2020","journal-title":"JACC Basic Transl Sci"},{"key":"2026100812221217500_xuag027-B31","doi-asserted-by":"publisher","first-page":"682726","DOI":"10.3389\/fendo.2021.682726","article-title":"Inhibition of the renin-angiotensin system reduces gene expression of inflammatory mediators in adipose tissue independent of energy balance","volume":"12","author":"Mitchell","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026100812221217500_xuag027-B32","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1185\/03007995.2016.1171204","article-title":"Effects of telmisartan on fat distribution: a meta-analysis of randomized controlled trials","volume":"32","author":"Choi","year":"2016","journal-title":"Curr Med Res Opin"},{"key":"2026100812221217500_xuag027-B33","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1161\/CIRCULATIONAHA.104.528166","article-title":"Effects of candesartan on the development of a new diagnosis of diabetes mellitus in patients with heart failure","volume":"112","author":"Yusuf","year":"2005","journal-title":"Circulation"},{"key":"2026100812221217500_xuag027-B34","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/01.hjh.0000194119.42722.21","article-title":"New-onset diabetes and antihypertensive drugs","volume":"24","author":"Mancia","year":"2006","journal-title":"J Hypertens"},{"key":"2026100812221217500_xuag027-B35","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1016\/j.jacc.2011.05.042","article-title":"Lipolytic effects of B-type natriuretic peptide 1-32 in adipose tissue of heart failure patients compared with healthy controls","volume":"58","author":"Polak","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B36","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/S2213-8587(17)30087-6","article-title":"Effect of sacubitril\/valsartan versus enalapril on glycaemic control in patients with heart failure and diabetes: a post-hoc analysis from the PARADIGM-HF trial","volume":"5","author":"Seferovic","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026100812221217500_xuag027-B37","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.ijcard.2018.03.089","article-title":"Effect of beta-adrenergic blockade on weight changes in patients with chronic heart failure","volume":"264","author":"Sze","year":"2018","journal-title":"Int J Cardiol"},{"key":"2026100812221217500_xuag027-B38","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1054\/jcaf.2002.130238","article-title":"Effect of selective and nonselective beta-blockers on resting energy production rate and total body substrate utilization in chronic heart failure","volume":"8","author":"Podbregar","year":"2002","journal-title":"J Card Fail"},{"key":"2026100812221217500_xuag027-B39","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.jchf.2024.10.023","article-title":"Growth differentiation factor-15 is associated with congestion-related anorexia and weight loss in advanced heart failure","volume":"13","author":"Monzo","year":"2025","journal-title":"JACC Heart Fail"},{"key":"2026100812221217500_xuag027-B40","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/j.jchf.2023.03.017","article-title":"Beta-blocker use and heart failure outcomes in mildly reduced and preserved ejection fraction","volume":"11","author":"Arnold","year":"2023","journal-title":"JACC Heart Fail"},{"key":"2026100812221217500_xuag027-B41","doi-asserted-by":"publisher","first-page":"e1916598","DOI":"10.1001\/jamanetworkopen.2019.16598","article-title":"Association of beta-blocker use with heart failure hospitalizations and cardiovascular disease mortality among patients with heart failure with a preserved ejection fraction: a secondary analysis of the TOPCAT trial","volume":"2","author":"Silverman","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026100812221217500_xuag027-B42","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.jchf.2023.09.007","article-title":"Contemporary use and implications of beta-blockers in patients with HFmrEF or HFpEF: the DELIVER trial","volume":"12","author":"Peikert","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2026100812221217500_xuag027-B43","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1007\/s00392-024-02451-0","article-title":"Beta blockers are associated with lower all-cause mortality among HFpEF patients","volume":"113","author":"Ibrahim","year":"2024","journal-title":"Clin Res Cardiol"},{"key":"2026100812221217500_xuag027-B44","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B45","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1185\/03007990903533681","article-title":"Effects of beta-blockers on glucose and lipid metabolism","volume":"26","author":"Fonseca","year":"2010","journal-title":"Curr Med Res Opin"},{"key":"2026100812221217500_xuag027-B46","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1161\/01.HYP.37.2.250","article-title":"Hypothesis: beta-adrenergic receptor blockers and weight gain: a systematic analysis","volume":"37","author":"Sharma","year":"2001","journal-title":"Hypertension"},{"key":"2026100812221217500_xuag027-B47","doi-asserted-by":"publisher","first-page":"1815","DOI":"10.2174\/138161208784746716","article-title":"Role of the autonomic nervous system and neuropeptides in the development of obesity in humans: targets for therapy?","volume":"14","author":"Greenfield","year":"2008","journal-title":"Curr Pharm Des"},{"key":"2026100812221217500_xuag027-B48","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1161\/01.CIR.0000065187.80707.18","article-title":"Beta-blockers in chronic heart failure","volume":"107","author":"Gheorghiade","year":"2003","journal-title":"Circulation"},{"key":"2026100812221217500_xuag027-B49","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC Guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B50","doi-asserted-by":"publisher","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B51","doi-asserted-by":"publisher","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B52","doi-asserted-by":"publisher","first-page":"4472","DOI":"10.1210\/jc.2007-1088","article-title":"Body mass index predicts aldosterone production in normotensive adults on a high-salt diet","volume":"92","author":"Bentley-Lewis","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"2026100812221217500_xuag027-B53","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1002\/ejhf.1167","article-title":"Derangements in adrenergic-adipokine signalling establish a neurohormonal basis for obesity-related heart failure with a preserved ejection fraction","volume":"20","author":"Packer","year":"018","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B54","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1161\/CIRCULATIONAHA.115.018226","article-title":"Adipocyte-derived hormone leptin is a direct regulator of aldosterone secretion, which promotes endothelial dysfunction and cardiac fibrosis","volume":"132","author":"Huby","year":"2015","journal-title":"Circulation"},{"key":"2026100812221217500_xuag027-B55","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1038\/hr.2016.72","article-title":"The angiotensin II type 1 receptor-neprilysin inhibitor LCZ696 blocked aldosterone synthesis in a human adrenocortical cell line","volume":"39","author":"Miura","year":"2016","journal-title":"Hypertens Res"},{"key":"2026100812221217500_xuag027-B56","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms","volume":"364","author":"Zannad","year":"2011","journal-title":"N Engl J Med"},{"key":"2026100812221217500_xuag027-B57","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1002\/ejhf.792","article-title":"Effect of eplerenone in patients with heart failure and reduced ejection fraction: potential effect modification by abdominal obesity. Insight from the EMPHASIS-HF trial","volume":"19","author":"Olivier","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B58","doi-asserted-by":"publisher","first-page":"2810","DOI":"10.1002\/ejhf.3665","article-title":"Mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction according to body weight","volume":"27","author":"Butt","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B59","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.amjcard.2021.01.018","article-title":"Effect of obesity on response to spironolactone in patients with heart failure with preserved ejection fraction","volume":"146","author":"Elkholey","year":"2021","journal-title":"Am J Cardiol"},{"key":"2026100812221217500_xuag027-B60","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.jchf.2019.09.009","article-title":"Clinical phenogroups in heart failure with preserved ejection fraction: detailed phenotypes, prognosis, and response to spironolactone","volume":"8","author":"Cohen","year":"2020","journal-title":"JACC Heart Fail"},{"key":"2026100812221217500_xuag027-B61","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1038\/ijo.2010.227","article-title":"Neprilysin, obesity and the metabolic syndrome","volume":"35","author":"Standeven","year":"2011","journal-title":"Int J Obes (Lond)"},{"key":"2026100812221217500_xuag027-B62","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.jchf.2016.11.015","article-title":"Interaction between spironolactone and natriuretic peptides in patients with heart failure and preserved ejection fraction: from the TOPCAT trial","volume":"5","author":"Anand","year":"2017","journal-title":"JACC Heart Fail"},{"key":"2026100812221217500_xuag027-B63","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.jacc.2024.10.111","article-title":"Finerenone, obesity, and heart failure with mildly reduced\/preserved ejection fraction: prespecified analysis of FINEARTS-HF","volume":"85","author":"Butt","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B64","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1002\/oby.22574","article-title":"Estimated glomerular filtration rate bias in participants with severe obesity regardless of deindexation","volume":"27","author":"Guebre-Egziabher","year":"2019","journal-title":"Obesity (Silver Spring)"},{"key":"2026100812221217500_xuag027-B65","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1056\/NEJMoa2107038","article-title":"Empagliflozin in heart failure with a preserved ejection fraction","volume":"385","author":"Anker","year":"2021","journal-title":"N Engl J Med"},{"key":"2026100812221217500_xuag027-B66","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in patients with heart failure and reduced ejection fraction","volume":"381","author":"McMurray","year":"2019","journal-title":"N Engl J Med"},{"key":"2026100812221217500_xuag027-B67","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1056\/NEJMoa2022190","article-title":"Cardiovascular and renal outcomes with empagliflozin in heart failure","volume":"383","author":"Packer","year":"2020","journal-title":"N Engl J Med"},{"key":"2026100812221217500_xuag027-B68","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1056\/NEJMoa2206286","article-title":"Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction","volume":"387","author":"Solomon","year":"2022","journal-title":"N Engl J Med"},{"key":"2026100812221217500_xuag027-B69","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.1002\/ejhf.2308","article-title":"Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index","volume":"23","author":"Adamson","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B70","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1002\/ejhf.2728","article-title":"Weight change and clinical outcomes in heart failure with reduced ejection fraction: insights from EMPEROR-reduced","volume":"25","author":"Anker","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B71","doi-asserted-by":"publisher","first-page":"4406","DOI":"10.1093\/eurheartj\/ehac481","article-title":"Dapagliflozin for heart failure according to body mass index: the DELIVER trial","volume":"43","author":"Adamson","year":"2022","journal-title":"Eur Heart J"},{"key":"2026100812221217500_xuag027-B72","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1002\/ejhf.3221","article-title":"Body mass index and cardiorenal outcomes in the EMPEROR-preserved trial: principal findings and meta-analysis with the DELIVER trial","volume":"26","author":"Sattar","year":"2024","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B73","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1002\/ejhf.1111","article-title":"How accurate is clinical assessment of neck veins in the estimation of central venous pressure in acute heart failure? Insights from a prospective study","volume":"20","author":"Breidthardt","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B74","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1016\/S0735-1097(02)02059-4","article-title":"Plasma brain natriuretic peptide concentration: impact of age and gender","volume":"40","author":"Redfield","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B75","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1053\/ajkd.2003.50118","article-title":"B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study","volume":"41","author":"McCullough","year":"2003","journal-title":"Am J Kidney Dis"},{"key":"2026100812221217500_xuag027-B76","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.jacc.2005.08.050","article-title":"B-type natriuretic peptide levels in obese patients with advanced heart failure","volume":"47","author":"Horwich","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B77","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1016\/j.jacc.2025.08.028","article-title":"Natriuretic peptides, body mass index, and clinical outcomes in heart failure with mildly reduced or preserved ejection fraction","volume":"86","author":"Ostrominski","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B78","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1002\/ejhf.2377","article-title":"Uncoupling between intravascular and distending pressures leads to underestimation of circulatory congestion in obesity","volume":"24","author":"Obokata","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B79","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1002\/ehf2.12640","article-title":"Body mass index and B-lines on lung ultrasonography in chronic and acute heart failure","volume":"7","author":"Brainin","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2026100812221217500_xuag027-B80","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3390\/diagnostics15010045","article-title":"The role of lung ultrasound scan in different heart failure scenarios: current applications and lacks of evidences","volume":"15","author":"Campora","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"2026100812221217500_xuag027-B81","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1056\/NEJMoa2203094","article-title":"Acetazolamide in acute decompensated heart failure with volume overload","volume":"387","author":"Mullens","year":"2022","journal-title":"N Engl J Med"},{"key":"2026100812221217500_xuag027-B82","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jacc.2007.09.043","article-title":"Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function?","volume":"51","author":"Mullens","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2026100812221217500_xuag027-B83","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.cardfail.2019.09.015","article-title":"Adverse renal response to decongestion in the obese phenotype of heart failure with preserved ejection fraction","volume":"26","author":"Reddy","year":"2020","journal-title":"J Card Fail"},{"key":"2026100812221217500_xuag027-B84","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1002\/ejhf.1697","article-title":"Evaluation of kidney function throughout the heart failure trajectory\u2014a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Mullens","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B85","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1002\/ejhf.2471","article-title":"Renal effects of guideline-directed medical therapies in heart failure: a consensus document from the Heart Failure Association of the European Society of Cardiology","volume":"24","author":"Mullens","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026100812221217500_xuag027-B86","doi-asserted-by":"publisher","first-page":"145","DOI":"10.3390\/jcm12010145","article-title":"Clinical recommendations to manage gastrointestinal adverse events in patients treated with Glp-1 receptor agonists: a multidisciplinary expert consensus","volume":"12","author":"Gorgojo-Martinez","year":"2022","journal-title":"J Clin Med"},{"key":"2026100812221217500_xuag027-B87","doi-asserted-by":"publisher","first-page":"3055","DOI":"10.1210\/jc.2003-031403","article-title":"Glucagon-like peptide 1 induces natriuresis in healthy subjects and in insulin-resistant obese men","volume":"89","author":"Gutzwiller","year":"2004","journal-title":"J Clin Endocrinol Metab"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjhf\/advance-article-pdf\/doi\/10.1093\/ejhf\/xuag027\/66753195\/xuag027.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/28\/2\/183\/66753195\/xuag027.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/28\/2\/183\/66753195\/xuag027.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:22:19Z","timestamp":1791476539000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/28\/2\/183\/8460651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":87,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,4]]},"published-print":{"date-parts":[[2026,5,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ejhf\/xuag027","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,2]]}}}