Beta blockers play a rather obscure role in HFpEF treatment though there is suggestion of a beneficial role in patient management.[50] Evidence from a meta-analysis demonstrated significant reductions in all cause mortality with beta-blocker therapy, though overall effects were driven largely by small, older trials of patients post-myocardial infarction.[51] Some evidence suggests that vasodilating beta blockers, such as nebivolol, can provide a benefit for patients with heart failure regardless of ejection fraction.[52] Additionally, because of the chronotropic perturbation and diminished LV filling seen in HFpEF the bradycardic effect of beta blockers may enable improved filling, reduce myocardial oxygen demand, and lower blood pressure. However, this effect also can contribute to diminished response to exercise demands and can result in an excessive reduction in heart rate.[53][54]