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Pathophysiologic Context In PAH + HFpEF overlap: * ETA receptors drive vasoconstriction, hypertrophy, and fibrosis * ETB receptors mediate endothelin clearance, nitric oxide release, and natriuresis * HFpEF patients rely on ETB signaling to maintain volume balance and endothelial function Blocking ETB in HFpEF increases the risk of fluid retention and rising leftsided filling pressures