Heart failure with preserved ejection fraction accounts for up to 50% of hospitalized heart failure patients and is associated with significant mortality and morbidity. The pathophysiology is heterogeneous and not very well defined, which explains the lack of disease-specific therapies. The principles of treating heart failure with preserved ejection fraction are controlling volume with diuretics and diet, and controlling the comorbidities, mainly the hypertension. Further research is encouraged to ascertain the key components of the disease that will serve as targets for therapy.