The aldosterone receptor antagonists spironolactone and eplerenone have been shown to be beneficial in HF and should be included in the regimen if there is HF (NYHA class II IV) with reduced ejection frac- tion (<40%). One or the other may be substituted for a thiazide diuretic in patients requiring a potassium- sparing agent. If an aldosterone receptor antagonist is administered with an ACE inhibitor or an ARB or in the presence of renal insufficiency, serum potas- sium should be monitored frequently. These drugs should not be used, however, if the serum creatinine level is 2.5 mg/dL in men or 2.0 mg/dL in wom- en or if the serum potassium level is 5.0 mEq/L. Spironolactone or eplerenone may be used with a thiazide or thiazide-like diuretic, particularly in pa- tients with resistant hypertension (Class I; Level of Evidence A). 6. Hydralazine plus isosorbide dinitrate should be add- ed to the regimen of diuretic, ACE inhibitor or ARB, and -blocker in African American patients with NYHA class III or IV HF with reduced ejection frac- tion (Class I; Level of Evidence A). Others may benefit similarly, but this has not yet been tested. 7. In patients who have hypertension and HF with pre- served ejection fraction, the recommendations are to control systolic and diastolic hypertension (Class I; Level of Evidence A), ventricular rate in the pres- ence of atrial fibrillation (Class I; Level of Evidence C), and pulmonary congestion and peripheral edema (Class I; Level of Evidence C). 8. Use of -adrenergic blocking agents, ACE inhibitors, ARBs, or CCBs in patients with HF with preserved ejection fraction and hypertension may be effective to minimize symptoms of HF (Class IIb; Level of Evidence C). 9. 