Loop diuretics are preferred over thiazide and thiazide-type diuretics for patients with ACS who have HF (NYHA class III or IV) or for patients with CKD and an estimated glomerular filtration rate <30 mL/min. For patients with persistent hypertension not controlled with a -blocker, an ACE inhibitor, and an aldosterone antagonist, a thiazide or thiazide-type diuretic may be added in selected patients for BP control (Class I; Level of Evidence B). 7. The target BP is <140/90 mmHg in patients with ACS who are hemodynamically stable (Class IIa; Level of Evidence C). A BP target of <130/80 mmHg at the time of hospital discharge is a reasonable op- tion (Class IIb; Level of Evidence C).The BP should be lowered slowly, and caution is advised to avoid decreases in DBP to <60 mmHg because this may reduce coronary perfusion and worsen ischemia. 6. Management of Hypertension in HF of Ischemic Origin Although guidelines from the ACC and the AHA exist for the treatment of chronic HF,177,209 evidence on which to base guidelines for the treatment of hypertension in patients with HF of ischemic origin is limited. On the basis of informa- tion from the Acute Decompensated Heart Failure National 75% of patients hospitalized with HF had hypertension, with most having SBPs >140 mmHg. In the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE-HF), >60% of patients seen in outpatient cardiology practices had a history of hypertension.211 Additional observational data from the Duke Databank for Cardiovascular Disease suggest a similar prevalence of hypertension in patients with ischemic 6.1. 