Treating Hypertension in Stage C HFrEF: Recommendation Recommendation for Hypertension in Stage C HFrEF COR LOE Recommendation Comment/Rationale I C-EO Patients with HFrEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg.191 NEW: Recommendation has been adapted from recent clinical trial data but not specifically tested per se in a randomized trial of patients with HF. See Online Data Supplements E and F. Clinical trials evaluating goal blood pressure reduction and optimal blood pressure lowering agents in the setting of HFrEF and concomitant hypertension have not been done. However, it is apparent that in those patients at higher risk, blood pressure lowering is associated with fewer adverse cardiovascular events. GDMT for HFrEF with agents known to lower blood pressure should consider a goal blood pressure reduction consistent with a threshold now associated with improved clinical outcomes but not yet proven by RCTs in a population with HF. 9.5.3. Treating Hypertension in Stage C HFpEF: Recommendation Recommendation for Hypertension in Stage C HFpEF COR LOE Recommendation Comment/Rationale I C-LD Patients with HFpEF and persistent hypertension after management of volume overload should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg.9,167,169,170,195 199 NEW: New target goal blood pressure based on updated interpretation of recent clinical trial data. See Online Data Supplements E and F. The use of nitrates in the setting of HFpEF is associated with a signal of harm and, in most situations, should be avoided. For many common antihypertensive agents, including alpha blockers, beta blockers, and calcium channel blockers, there are limited data to guide the choice of antihypertensive therapy in the setting of HFpEF.172 Nevertheless, RAAS inhibition with ACE inhibitor, ARB (especially mineralocorticoid receptor antagonists), and possibly ARNI would represent the preferred choice. 