The impact of renal denervation in HF patients is also unclear, and future ran- domized trials are needed to clarify its role in this patient population. 6.9. Goal BP Healthcare providers should lower both SBP and DBP in accordance with the recommendations provided in pub- lished guidelines, including the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.3 BP targets in HF have not been firmly established, but in most successful tri- als, SBP was lowered to the range of 110 to 130 mmHg. One demonstrated benefits of carvedilol in patients with entry criteria that included SBPs down to 85 mmHg and who had a mean pretreatment BP of 123/76 mmHg, which suggests that lower BPs (SBP <120 mmHg) may be desirable in some patients. Therefore, we make the rec- ommendation that the target BP in patients with HF should be <140/90 mmHg, but we also suggest that consideration should be given to lowering the BP even further, to <130/80 mmHg. Octogenarians should be checked for orthostatic changes with standing, and an SBP <130 mmHg and a DBP <65 mmHg should be avoided. 6.10. Drugs to Avoid Several classes of drugs should be avoided in patients with isch- emic systolic HF with hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, nondihydropyridine CCBs such as diltiazem and verapamil should be avoided.278 The dihydropyridine CCB amlo- dipine appeared to be safe in patients with severe systolic HF in the Prospective Randomized Amlodipine Survival Evaluation as was felodipine as supplementary vasodila- tor therapy in the Vasodilator-Heart Failure Trial (V-HeFT) III.280 Although clonidine is an effective antihypertensive agent, another druginthesameclass,moxonidine,wasassociatedwithincreased mortality in patients with HF281 ; therefore, clonidine also should probably be avoided. 