Patients with an LV ejec- tion fraction of <40% were randomly assigned at 3 to 14 days after MI to therapy with eplerenone or placebo. During a mean follow-up of 16 months, eplerenone significantly improved mor- tality by 15%.112 The EMPHASIS trial supported the benefits of eplerenone in chronic HF (LV ejection fraction 35%) with mild symptoms (NYHA class II), in which there was a 37% reduction in the primary end point of cardiovascular death or HF hospi- Although these trials did not specifically evaluate patients with hypertension and HF, the improvement in relative risk with eplerenone was greater in the subgroup with a history of hypertension than in normotensive subjects,112 which suggests that these agents may be particularly beneficial in patients with hypertension and HF. This class of drug is especially beneficial in patients with hypokalemia.273 Electrolytes and renal function should be monitored to prevent hyperkalemia. 6.8. Renal Denervation The radiofrequency ablation of renal sympathetic nerves has recently gained attention for its ability to reduce BP in those with resistant hypertension.274,275 A small study has demonstrated the ability of renal denervation to induce LV hypertrophy regression and to improve LV systolic and dia- However, in the first large-scale clinical trial of renal denervation in patents with resistant hyper- tension, with an appropriate control group, namely a sham procedure (Renal Denervation in Patients With Uncontrolled Hypertension [SYMPLICITY HTN-3]),277 there was no sig- nificant difference between the 2 groups in the reduction of SBP, which leaves the future of renal denervation in the management of hypertension uncertain. The impact of renal denervation in HF patients is also unclear, and future ran- domized trials are needed to clarify its role in this patient population. 6.9. 