The treatment of hypertension in patients with HF should include behavioral modifica- tion such as sodium restriction and a closely monitored exercise program.48 Weight reduc- tion in obese or overweight, a heart-healthy diet, and moderation of alcohol intake in Bozkurt et al individuals with 140 mmHg SBP or 90 mmHg diastolic BP are recommended (Class I; Level of Evidence C).7,9,14,48 4. Thiazide or thiazide-like diuretics can be use- ful for BP control and to reverse mild volume overload and associated symptoms in symp- tomatic patients with HF with volume over- load. Loop diuretics, which are the preferred agents for treatment of congestion in symp- tomatic patients with HF, are less effective than thiazide or thiazide-like diuretics in low- ering BP (Class IIa; Level of Evidence C).7,8,48 5. The addition of hydralazine/isosorbide dini- trate to the background treatment with an ACE inhibitor or ARB and a -blocker may be benefi- cial in nonblack patients with HFrEF and hyper- tension (Class IIa; Level of Evidence C).8,71 6. Drugs to avoid in patients with HF and hyper- tension are nondihydropyridine calcium chan- nel blockers (eg, verapamil and diltiazem) and moxonidine (Class III: Harm; Level of Evidence C). -Adrenergic blockers such as doxazosin should be avoided and might be used only if other drugs for the management of hyper- tension and HF are inadequate to achieve BP control at maximum tolerated doses (Class III: Harm; Level of Evidence C).8,14,29,48 Paradox: Once HFrEF Is Manifest, Higher BP Is Associated With Better Prognosis An epidemiological paradox exists in the HF-hyperten- sion relationship. Although hypertension results in the development of HF, once advanced HFrEF is manifest, lower BP is associated with a worse prognosis, and simi- larly, a higher BP is associated with a better prognosis. 