Although thiazide or thiazide-like diuretics are usually recommended for the treatment of hypertension,7 in pa- tients with current or prior symptoms of HF who have evi- dence of fluid retention, loop diuretics are usually used8 (Table 4). It should be noted, however, that loop diuret- ics are usually less effective than thiazide or thiazide-like diuretics in lowering BP8 and thus should be used for the management of hypertension in patients with symp- tomatic HF with congestion. For patients with stage C HFrEF, ACE inhibitors (or ARBs in ACE inhibitor intolerant patients), -blockers, and aldosterone antagonists are titrated to target doses as tolerated. BP is frequently within the target range or lower after careful titration of these agents. In those for whom BP remains in the hy- pertensive range, further increases of the recommend- ed agents may be considered. Reasonable next steps would be the addition of other medications with proven benefit in HF populations such as ARBs or aldosterone antagonists or the addition of nitrates or hydralazine. Treatment of Refractory Hypertension in HF Most patients with advanced stage C or D HF do not manifest hypertension and may actually develop hy- potension resulting from pump failure and an inability to raise the BP. However, if a patient with HFrEF has refractory hypertension, there are no definitive studies to provide guidance on the efficacy and safety of addi- tional antihypertensive approaches when recommended HF therapies are inadequate to treat BP. Nondihydro- pyridine calcium channel blockers (diltiazem, verapamil) are used to treat hypertension, but they are not recom- mended as routine treatment for patients with HFrEF.8 Amlodipine and felodipine neither improve nor worsen the survival of patients with HF72,73 ; therefore, a dihy- dropyridine group of calcium channel blockers could be used to control hypertension only after other medica- tions have failed. 