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We first elaborate on the heterogeneity of cardiac macrophages and the diverse clinical and preclinical phenotypes of HFpEF. We then synthesize evidence demonstrating how risk factors, like aging, cardiometabolic disease, and hypertension, induce profound phenotypic switching and functional reprogramming of macrophages across different HFpEF subtypes. Subsequently, we detail how these reprogrammed macrophages, in turn, propagate disease progression by promoting inflammation, fibrosis, and endothelial dysfunction through complex interactions with cardiomyocytes, fibroblasts, and other cellular components. 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