Abstract
Heart failure with preserved ejection fraction (HFpEF) is a multifactorial cardiovascular disorder characterized by diastolic dysfunction, systemic inflammation, and myocardial fibrosis. Emerging evidence indicates that macrophage polarization imbalance plays a central role in HFpEF pathogenesis. Traditional Chinese medicine (TCM) has demonstrated therapeutic potential in modulating macrophage activity through pathways such as NO/cGMP/PKG, TGF-β/Smads, and PI3K/Akt, thereby exerting anti-inflammatory, antifibrotic, and antioxidant effects. In this review, we conducted a literature search in PubMed, Google Scholar, Web of Science, and CNKI for studies published up to May 2025, using the terms "HFpEF", "Traditional Chinese Medicine", and "macrophage". A total of 19 relevant studies were included. We highlight representative TCM metabolites and TCM formulas, such as resveratrol, Qishen Yiqi Pill, Shenfu Injection, etc. And we summarize their mechanisms in regulating M1/M2 macrophage polarization. Finally, we identify current challenges, including limited HFpEF-specific models and insufficient mechanistic validation, and propose directions for future research.