Heart Failure Guidelines: Preserved Ejection Fraction and Comorbidities

The new guidelines regarding the management of hypertension¹  are for patients in stage C heart failure with reduced ejection fraction (HFrEF). As “clinical trials evaluating goal blood pressure reduction and optimal blood pressure–lowering agents in the setting of HFrEF and concomitant hypertension have not been done,”¹  the recommendation may be considered “controversial” by some. However, “in those patients at higher risk, blood pressure lowering is associated with fewer adverse cardiovascular events.”¹  Thus, my opinion is that for patients at higher risk, lowering the blood pressure to the new, lower level using diet and exercise modification in addition to medications may be beneficial and result in fewer adverse cardiovascular events. The Joint National Committee guidelines²  address hypertension in the general population and hypertension in patients with chronic kidney disease or diabetes, whereas the new guidelines address hypertension only in patients in stage C HFrEF.

For patients with...