Given the lack of ran- domized trial evidence to support the use of hydralazine without a nitrate in the treatment of primary hypertension and concerns that hydralazine may provoke angina, monotherapy with hydrala- zine in IHD is not recommended. 1. The treatment of hypertension in patients with HF should include management of risk factors such as dyslipidemia, obesity, diabetes mellitus, smoking, and dietary sodium and a closely monitored exercise program (Class I; Level of Evidence C). 2. Drugs that have been shown to improve outcomes for patients with HF with reduced ejection fraction gen- erally also lower BP. Patients should be treated with ACE inhibitors (or ARBs), -blockers (carvedilol, metoprolol succinate, bisoprolol, or nebivolol), and aldosterone receptor antagonists (Class I; Level of Evidence A). 3. Thiazide or thiazide-type diuretics should be used for BP control and to reverse volume overload and asso- ciated symptoms. In patients with severe HF (NYHA class III and IV) or those with severe renal impair- ment (estimated glomerular filtration rate <30 mL/ min), loop diuretics should be used for volume con- trol, but they are less effective than thiazide or thia- zide-type diuretics in lowering BP. Diuretics should be used together with an ACE inhibitor or ARB and a -blocker (Class I; Level of Evidence C). 4. Studies have shown equivalence of benefit of ACE inhibitors and the ARBs candesartan or valsartan in HF with reduced ejection fraction. Either class of agents is effective in lowering BP (Class I; Level of Evidence A). 5. 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%). 