Thus, in patients with a recent or remote history of MI or acute coronary syndrome and reduced ejection fraction (EF), ACE inhibitors49 51 (or ARBs if the patient is ACE inhibitor intolerant30,52 ) prevent symptomatic HF and reduce mortality. Similarly, in patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, -blockers reduce mortality.53 55 In patients with a reduced EF but without any history of MI or symp- toms of HF, ACE inhibitors prevent symptomatic HF,51,56 and - blockers can improve symptoms, ameliorate LV Table 3. Recommendations for the Treatment of Hypertension in Stage B HF: Patients With Cardiac Structural Abnormalities or Remodeling Who Have Not Developed HF Symptoms Recommendations COR LOE Referenced Guideline References In patients with structural cardiac abnormalities, including LV hypertrophy, BP should be controlled in accordance with clinical practice guidelines for hypertension to prevent symptomatic HF. Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF. - Adrenergic blockers such as doxazosin should be avoided and might be used only if other drugs for the management of hypertension and HF are inadequate to achieve BP control at maximum tolerated doses. ACE indicates angiotensin-converting enzyme; ACS, acute coronary syndrome; ARB, angiotensin receptor blocker; BP, blood pressure; COR, Class of Recommendation; HF, heart failure; LOE, Level of Evidence; LV, left ventricular; LVEF, left ventricular ejection fraction; and MI, myocardial infarction. Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES remodeling, and improve LV function.57,58 Although these beneficial effects of ACE inhibitors, ARBs, and -blockers are not specific for patients with hypertension or for treatment of BP, a significant proportion of patients in these trials (40% 60%) had a history of hypertension, and the beneficial effects could be generalized to the hypertensive population. 