Journal of the American College of Cardiology
Clinical Practice Guideline: Focused Update
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart FailureA Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America
Clyde W. Yancy, Mariell Jessup, Biykem Bozkurt, Javed Butler, Donald E. Casey Jr., Monica M. Colvin, Mark H. Drazner, Gerasimos S. Filippatos, Gregg C. Fonarow, Michael M. Givertz, Steven M. Hollenberg, JoAnn Lindenfeld, Frederick A. Masoudi, Patrick E. McBride, Pamela N. Peterson, Lynne Warner Stevenson and Cheryl Westlake
Table13
Recommendation for Hypertension in Stage C HFpEF
| COR | LOE | Recommendation | Comment/Rationale |
|---|---|---|---|
| I | C-LD | Patients with HFpEF and persistent hypertension after management of volume overload should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg (9,167,169,170,195–199). | NEW: New target goal blood pressure based on updated interpretation of recent clinical trial data. |
| See Online Data Supplements E and F. | |||
| The use of nitrates in the setting of HFpEF is associated with a signal of harm and, in most situations, should be avoided. For many common antihypertensive agents, including alpha blockers, beta blockers, and calcium channel blockers, there are limited data to guide the choice of antihypertensive therapy in the setting of HFpEF (172). Nevertheless, RAAS inhibition with ACE inhibitor, ARB (especially mineralocorticoid receptor antagonists), and possibly ARNI would represent the preferred choice. A shared decision-making discussion with the patient influenced by physician judgment should drive the ultimate choice of antihypertensive agents. | |||
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