TABLE 4

Recommendations for managing blood pressure in heart failure

Patient group	Class^a
With hypertension at increased risk
< 130/80 mm Hg should be the optimal blood pressure	I
With heart failure with reduced ejection fraction
Guideline-directed medical treatment titrated to attain a blood pressure of < 130/80 mm Hg	I
Nondihydropyridine calcium channel blockers not recommended	III
With heart failure with preserved ejection fraction and symptoms of volume overload
Diuretics to control hypertension	I
With heart failure with preserved ejection fraction and persistent hypertension after management of volume overload
Guideline-directed medical therapy titrated to attain systolic blood pressure < 130 mm Hg. Although there are limited data to guide the choice of antihypertensive therapy in HFpEF, preferred agents include RAAS inhibition with ACE-I, ARB, and mineralocorticoid receptor antagonists (spironolactone).	I
Nitrates not recommended in HFpEF, unless given for symptomatic coronary artery disease, due to association with a signal of harm or decreased exercise tolerance.	III

↵a Class of recommendation (I strong, III no benefit).
ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; HFpEF = heart failure with preserved ejection fraction; RAAS = renin-angiotensin-aldosterone system
Information from reference 1.