Use of -adrenergic blocking agents, ACE inhibitors, ARBs, or CCBs in patients with HF with preserved ejection fraction and hypertension may be effective to minimize symptoms of HF (Class IIb; Level of Evidence C). 9. In IHD, the principles of therapy for acute hyperten- sion with pulmonary edema are similar to those for STEMI and NSTEMI, as described above (Class I; Level of Evidence A). If the patient is hemodynamical- ly unstable, the initiation of these therapies should be delayed until stabilization of HF has been achieved. Drugs to avoid in patients with hypertension and HF with reduced ejection fraction are nondihydro- pyridine CCBs (such as verapamil and diltiazem), clonidine, moxonidine, and hydralazine without a nitrate (Class III Harm; Level of Evidence B). - Adrenergic blockers such as doxazosin should be used only if other drugs for the management of hy- pertension and HF are inadequate to achieve BP control at maximum tolerated doses. Nonsteroidal anti-inflammatory drugs should also be used with caution in this group, given their effects on BP, vol- ume status, and renal function (Class IIa; Level of Evidence B). The target BP is <140/90 mmHg, but consideration can be given to lowering the BP even further, to <130/80 mmHg. In patients with an elevated DBP who have CAD and HF with evidence of myocardial ischemia, the BP should be lowered slowly. In older hypertensive individuals with wide pulse pressures, lowering SBP may cause very low DBP values (<60 mmHg). This should alert the clinician to assess care- fully any untoward signs or symptoms, especially those caused by myocardial ischemia and worsening HF (Class IIa; Level of Evidence B). Octogenarians should be checked for orthostatic changes with stand- ing, and an SBP <130 mmHg and a DBP <65 mmHg should be avoided. 