What medications are generally recommended for the treatment of HFrEF with refractory hypertension?
A triple-drug regimen of an ACE inhibitor or ARB, a calcium channel blocker, and a thiazide diuretic is effective and can be well tolerated for the treatment of HFrEF with refractory hypertension. Carvedilol, one of the beta-blockers proven to reduce mortality in HF, is more effective in reducing BP than metoprolol succinate or bisoprolol due to its combined alpha-blocking properties and may be the beta-blocker of choice among beta-blockers in patients with HFrEF with refractory hypertension. Experience with other beta-blockers with vasodilatory properties such as nebivolol is very limited and they are not the beta-blocker of choice for the treatment of HFrEF according to HF guidelines.8