What should be done to address hypotensive symptoms due to over-diuresis, use of non-CV drugs with hemodynamic effects, autonomic dysfunction, or simultaneous administration of multiple HF medications?
Hypotensive symptoms due to over-diuresis, use of non-CV drugs with hemodynamic effects, autonomic dysfunction, or simultaneous administration of multiple HF medications should be addressed before deciding to lower doses of evidence-based therapies. After excluding other causes of hypotension, use best-tolerated doses of GDMT, accepting that less data exist for the impact of lower doses in HF management. Clinical comorbidities and clinical judgment should be used to guide which GDMTs are reduced. For persistent hypotension, consider referral to an advanced HF specialist.