Nondihydropyridine CCBs are not recommended in the treatment of hypertension in adults with HFrEF.S9.2.1-1 Synopsis Approximately 50% of patients with HF have HFrEF.S9.2.1-2 S9.2.1-6 Numerous RCTs have shown that treatment of HFrEF with GDMT reduces mortality and HF hospitalizations.S9.2.1-7 Large-scale RCTs have shown that antihypertensive drug therapy reduces the incidence of HF in patients with In ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), chlorthalidone reduced the risk of HFrEF more than amlo- dipine and doxazosin but similarly to lisinopril.S9.2.1-12,S9.2.1-13 Recommendation-Specific Supportive Text 1. This recommendation is based on guidance in the 2017 ACC/AHA/HFSA guideline focused update on heart (see figure from the HF focused update that is reproduced in Online Data Supplement A). Lifestyle modification, such as weight loss and sodium reduction, may serve as adjunctive measures to help these agents work better. No RCT evidence is available to support the superiority of one BP-lowering medication with compel- ling indications for treatment of HFrEF over another. Medications with compelling indications for HF that may be used as first-line therapy to treat high BP include ACE inhibitors or ARBs, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, diuret- ics, and GDMT beta blockers (carvedilol, metoprolol succinate, or bisoprolol). Clinical trials evaluating goal BP reduction and opti- mal BP-lowering agents in the setting of HFrEF and con- comitant hypertension have not been performed. However, in patients at higher CVD risk, BP lowering is associated with fewer adverse cardiovascular events.S9.2.1-7 GDMT for HFrEF with agents known to lower BP should consider a goal BP reduction consistent with a threshold now associ- ated with improved clinical outcomes but not yet proven by RCTs in an HF population. 2. Nondihydropyridine CCBs (verapamil, diltiazem) have myocardial depressant activity. 