In this recommendation, however, the term GDEM has been used to denote this same concept in order to reflect the original wording of the recommendation that initially appeared in the 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. 10 Yancy et al 7.3.3. Pharmacological Treatment for Stage C HFpEF: Recommendations Recommendations for Stage C HFpEF COR LOE Recommendations Comment/Rationale I B Systolic and diastolic blood pressure should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to 2013 recommendation remains current. I C Diuretics should be used for relief of symptoms due to volume overload in patients with HFpEF. 2013 recommendation remains current. IIa C Coronary revascularization is reasonable in patients with CAD in whom symptoms (angina) or demonstrable myocardial ischemia is judged to be having an adverse effect on symptomatic HFpEF despite GDMT. 2013 recommendation remains current. IIa C Management of AF according to published clinical practice guidelines in patients with HFpEF is reasonable to improve symptomatic HF. 2013 recommendation remains current (Section 9.1 in the 2013 HF guideline). IIa C The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with HFpEF. 2013 recommendation remains current. Figure 2. Treatment of HFrEF Stage C and D. Colors correspond to COR in Table 1. For all medical therapies, dosing should be optimized and serial assessment exercised. *See text for important treatment directions. Hydral-Nitrates green box: The combination of ISDN/HYD with ARNI has not been robustly tested. BP response should be carefully monitored. See 2013 HF guideline.9 Participation in investigational studies is also appropriate for stage C, NYHA class II and III HF. 