What is the recommendation for treating hypertension in Stage C HFrEF?
The recommendation for treating hypertension in Stage C HFrEF is that patients should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg. This recommendation has been adapted from recent clinical trial data, but has not been specifically tested in a randomized trial of patients with HF. Clinical trials evaluating goal blood pressure reduction and optimal blood pressure lowering agents in the setting of HFrEF and concomitant hypertension have not been done, however, it is apparent that in those patients at higher risk, blood pressure lowering is associated with fewer adverse cardiovascular events. GDMT for HFrEF with agents known to lower blood pressure should consider a goal blood pressure reduction consistent with a threshold now associated with improved clinical outcomes but not yet proven by RCTs in a population with HF. 