Drugs to Avoid in Patients With HF Several classes of drugs should be avoided in patients with HFrEF with a history of hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, the nondihydropyridine cal- cium channel blockers such as diltiazem and verapamil should be avoided.8 The dihydropyridine calcium channel blocker amlodipine appeared to be safe in patients with severe HFrEF in the PRAISE trial (Prospective Randomized Amlodipine Survival Evaluation),82 as was felodipine.73 In the current 2013 HF guidelines, most calcium channel blocking drugs except amlodipine are not recommended.8 Although clonidine is an effective antihypertensive agent, a similar centrally acting drug, moxonidine, was associat- ed with increased mortality in patients with HF; thus, cen- trally acting norepinephrine-depleting agents may need to be avoided or used with caution in patients with HFrEF.83 In the ALLHAT trial, the -blocker doxazosin arm of the trial was discontinued because of a 2-fold increase in the risk of developing HF compared with chlorthalidone treat- Although the ALLHAT study excluded patients with established HF and there are caveats about extrapolating these data to the management of hypertension in patients with established HF, the safety and efficacy of -blockers in the management of patients with HF with hypertension are currently unclear. Potent direct-acting vasodilators such as minoxidil should also be avoided because of their renin-related salt and fluid-retaining effects. Nonsteroidal anti-inflammatory agents should be used with caution in these patients, given their effects on BP, volume status, and renal function. Treatment of Hypertension in Patients With HF With Preserved LVEF Most patients with HF and preserved LVEF (HFpEF), es- pecially elderly women, have hypertension. 