Managing hypertension with heart failure: a summary of the guidelines

  • Pinho-Gomes AC & al.
  • Heart
  • 23 Jan 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In heart failure (HF) with reduced ejection fraction (HFrEF), treating hypertension to a 130/80 mmHg target is a guidelines consensus.
  • In the absence of needed evidence, for HF with preserved ejection fraction (HFpEF), general guideline is to use the same strategy as with HFrEF.
  • The guideline summaries in this review also include a look at special populations, including older patients and those with diabetes.

Why this matters

  • HF and hypertension often accompany one another, but how BP treatment and medication affect HF outcomes is not entirely clear.
  • This review tabulates what various guidelines recommend and offers algorithms for treating hypertension in HFrEF and HFpEF.

Key points

  • 130/80 mmHg is the recommended target; caution urged with
  • For HFrEF, the algorithm suggests:
    • Recommended treatment:
      • Angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI) + beta-blocker (BB); or
      • Diuretic + mineralocorticoid receptor antagonist (MRA); or
      • Dihydropyridine-calcium channel blocker (CCB) + hydralazine.
    • To a target of:
  • For HFpEF:
    • Recommended treatment:
      • ACEI/ARB/MRA + diuretic;
      • BB (?), CCB, alpha-blockers.
    • Target:
      • 130/80 mmHg or lower if tolerated.
  • Special populations include:
    • Older patients: monotherapy, slow uptitration, close monitoring, BP target
    • Diabetes: ACEI/ARB + diuretic/dihydropyridine-CCB; target

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