In the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE-HF), >60% of patients seen in outpatient cardiology practices had a history of hypertension.211 Additional observational data from the Duke Databank for Cardiovascular Disease suggest a similar prevalence of hypertension in patients with ischemic 6.1. Hypertension and HF Most patients with HF have arterial hypertension.213 Not only is hypertension an important concomitant disorder, but it also contributes to the pathogenesis of both HF with reduced ejection fraction and HF with preserved ejection fraction. Hypertension is a major risk factor for IHD and can lead to the development of HF by causing LV hypertrophy, impaired cardiac myocyte contractility, ventricular chamber remodel- ing, and eventually ventricular dysfunction.214-216 Elevated levels of DBP and especially SBP are major risk fac- tors for the development of HF,217,218 and long-term treatment of both systolic and diastolic hypertension has been shown to reduce the risk of HF.93,123,219 The subsequent structural abnor- malities that occur in patients with hypertension, including LV hypertrophy or MI (eg, stage B HF), portend a higher number of Rosendorff et al Treatment of Hypertension in Patients With CAD 1393 adverse cardiovascular outcomes. Patients presenting with HF are more likely to be older and hypertensive, and more than half have a normal LV ejection fraction.210,220 Early investigations of patients with HF such as the Framingham Heart Study cited hypertension as the most frequent comorbidity; hypertension accounted for 39% of HF cases in men and 59% in women.217 In a population-based study in Olmstead County, Minnesota, 50% of patients presenting with new-onset HF had hyperten- However, recent randomized trials have probably under- estimated the contribution of hypertension to the development and progression of HF, possibly because elderly patients often are not included in clinical trials of HF. 