Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which a patient has signs and symptoms of heart failure including dyspnea, fatigue, pulmonary rales, peripheral edema and an ejection fraction greater than 50%.1-4 Approximately half of patients with heart failure have a preserved ejection fraction.2-5 HFpEF is considered a distinct clinical entity from other causes of heart failure with a preserved ejection fraction such as valvular heart disease, pericardial disease, and infiltrative cardiomyopathy. HFpEF carries a poor prognosis, with an annual mortality of 29% in patients discharged after an acute decompensated heart failure admission.5 5-year survival rates can be as poor as 50%.2 We know that patients with HFpEF are more likely to be older, female, and have hypertension.3,4 Hypertension, in fact, is present in 80-90% of patients with HFpEF.3 The aim of this work is to summarize current understanding of HFpEF and review the latest ACC/AHA management guidelines while highlighting studies which provide the evidence for and against particular management strategies.