What medications are recommended for patients with refractory hypertension in HFrEF?
For patients with refractory hypertension in HFrEF, reasonable next steps would be the addition of other medications with proven benefit in HF populations such as ARBs or aldosterone antagonists, or the addition of nitrates or hydralazine. Nondihydropyridine calcium channel blockers (diltiazem, verapamil) may also be used to treat hypertension, but they are not recommended as routine treatment for patients with HFrEF.8 Amlodipine and felodipine neither improve nor worsen the survival of patients with HF72,73 ; therefore, a dihydropyridine group of calcium channel blockers could be used to control hypertension only after other medications have failed.