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. Several clinical trials have demonstrated either no clinical benefit or even worse outcomes in patients with HF treated with these Therefore, nondihydropyridine CCBs are not recommended in patients with hypertension and HFrEF. Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e51 9.2.2. Heart Failure With Preserved Ejection Fraction Recommendations for Treatment of Hypertension in Patients With HFpEF References that support recommendations are summarized in Online Data Supplements 35 and 36. COR LOE Recommendations I C-EO 1. In adults with HFpEF who present with symptoms of volume overload, diuretics should be prescribed to control hypertension. I C-LD 2. Adults with HFpEF and persistent hypertension after management of volume overload should be prescribed ACE inhibitors or ARBs and beta blockers titrated to attain SBP of less than 130 Synopsis Approximately 50% of patients with HF have The ejection fraction in these studies has varied from >40% to 55%.S9.2.2-2 Patients with HFpEF are usually older women with a history of hypertension. 