Which medications are considered first-line in the pharmacological management of HRpEF?

The correct choice, which highlights the first-line medications for the pharmacological management of heart failure with preserved ejection fraction (HRpEF), is the angiotensin-converting enzyme inhibitors (ACEIs). ACEIs are beneficial in HRpEF due to their ability to help manage blood pressure, reduce the workload on the heart, and improve overall cardiovascular function. They also play a role in preventing heart remodeling and providing a protective effect on the kidneys, which can be particularly advantageous for patients with concomitant hypertension or renal issues.

Aldosterone antagonists, though beneficial in heart failure management, are generally used more for patients with heart failure with reduced ejection fraction (HFrEF) rather than HRpEF specifically. Diuretics, while effective at managing volume overload and heart failure symptoms, do not address the underlying pathophysiology in HRpEF. Angiotensin receptor blockers (ARBs) have similar actions to ACEIs and can be used in certain circumstances but are not deemed first-line therapy compared to ACEIs for HRpEF management.

Therefore, ACEIs are the cornerstone of treatment for HRpEF as their broad benefits in cardiovascular management assist in symptom relief and improving patients' functional status.