ACE and hydrops fetalis: While significant advances in reducing HF mortality and improving the cardiac function (Li et al., 2020) have been made in treating heart failure with reduced ejection fraction (HFrEF) (Komajda et al., 2018), pharmacological therapies for HFpEF including angiotensin receptor neprilysin inhibitor (ARNI), angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs) and mineralocorticoid receptor antagonists (MRAs), have generally been disappointing, with no convincing evidence of mortality or morbidity reduction.