Management of hypertension in heart failure: striking lack of evidence for a common problem.

Arterial hypertension is common either as a concomitant or pathogenetic entity in patients with systolic heart failure and in those with heart failure and normal ejection fraction. In free-living communities, more than half of the patients of heart failure with normal ejection fraction (HFnEF) have hypertension somewhat more than that occurring in presence of systolic heart failure. In acute heart failure, co-existent hypertension is much more frequent. Separate guidelines exist for management of hypertension and systolic heart failure. There are no published guidelines for management of HFnEF. There are contradictory recommendations with regard to drug management of hypertension and systolic heart failure. This review examines the available literature on this common co-existing combination and suggests some new recommendations.