In a substantial minority of patients with heart failure, the ejection fraction is normal (“diastolic heart failure”). The evidence base for treatment of such patients is less robust than that for patients with systolic heart failure, with few large randomized trials. International guidelines make few recommendations: fluid retention should be controlled with judicious use of diuretics, ventricular rate in atrial fibrillation should be controlled (and consideration given to returning to sinus rhythm), and identification and treatment of hypertension and myocardial ischemia is considered worthwhile. This approach contrasts markedly with the firm evidencebased recommendations for the use of neurohormonal antagonists (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, Βblockers, and aldosterone antagonists) for mortality and morbidity benefit in patients with systolic heart failure. (...)