ACE and hydrops fetalis: Studies of other pharmacological therapies in patients with cardiovascular and metabolic risk factors in whom pre-HF was present have shown reduced incident heart failure and cardiovascular events. In patients with pre-HF with reduced left ventricular ejection fraction, angiotensin-converting enzyme inhibitor therapy has been associated with a reduction in incident heart failure. However, the high prevalence of pre-HFpEF in community populations, an estimated 30% to 63% of older adults with hypertension or diabetes, underlines a need for more studies targeting this cohort.