However, these recommendations were empirical, not supported by trial evidence.9,48 Furthermore, there is con- cern about potential adverse outcomes with BP lowering that is too aggressive, which was further supported by the change to a higher BP threshold of 140/90 mmHg in patients <60 years of age and <150/90 mmHg in patients 60 years of age in the 2014 evidence-based guideline for the management of high BP in adults.7 It should be noted, however, that the writing committee did not address BP treatment targets in patients with es- tablished HF. The lack of definitive BP targets in patients with existing HF notwithstanding, treatment of HF is usu- Table 4. Recommendations for the Treatment of Hypertension in Stage C HF: Patients With Cardiac Structural Abnormalities or Remodeling With Prior or Current Symptoms of HF Recommendations COR LOE Referenced Guideline References Patients with previous or current symptoms of HFrEF should be treated with GDMT, including diuretics, ACE inhibitors (or ARBs if ACE inhibitor intolerant), -blockers, and aldosterone receptor antagonists, which have been proven to improve outcomes for patients with HF and can lower BP in hypertensive patients with HFrEF. I A for clinical outcomes, B for BP control Addition of hydralazine/isosorbide dinitrate to the background treatment with ACE inhibitor or ARB and -blocker in self-described black patients with HFrEF and persistent NYHA class III or IV HF symptoms is beneficial to reduce morbidity and mortality and can lower BP in hypertensive patients with HFrEF. I A for reduction in morbidity and mortality in HF, B for BP control The treatment of hypertension in patients with HF should include behavioral modification such as sodium restriction and a closely monitored exercise program. Weight reduction in overweight or obese, an appropriate diet, and moderation of alcohol intake are recommended in patients with hypertension. 