Furthermore, studies suggest potential adverse outcomes with these classes of agents that are elaborated below in the Drugs to Avoid in Patients With HF section. In addition to medication choices, the evaluation of patients with resistant hypertension should be directed toward confirming true treatment resistance, accurate assessment of treatment adherence and use of good BP measurement techniques to exclude pseudo-resistance, and identification of causes contributing to treatment re- sistance, including secondary causes of hypertension. In most cases, treatment resistance is multifactorial in origin, with obesity, excessive dietary sodium intake, ob- structive sleep apnea (OSA), and chronic kidney disease being particularly common factors in patients with HF. New antihypertension treatment strategies such as renin inhibition with aliskiren failed to improve clinical outcomes in patients with HF,80 and catheter-based renal artery denervation (SYMPLICITY HTN-3 trial [A Controlled Trial of Renal Denervation for Resistant Hypertension]) Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES failed to show a significant reduction of SBP in patients with resistant hypertension.81 Other strategies such as targeting excessive sympathetic nerve activity by carotid body denervation are awaiting clinical validation in the hypertension and HF populations. Drugs to Avoid in Patients With HF Several classes of drugs should be avoided in patients with HFrEF with a history of hypertension. 