What is the key recommendation for a patient with heart failure and reduced ejection fraction who also has high blood pressure?

For a patient with heart failure and reduced ejection fraction (HFrEF) who also presents with high blood pressure, initiating treatment with an aldosterone antagonist is a key recommendation. This approach aligns with established guidelines, which emphasize the significant benefits of aldosterone antagonists in managing heart failure and improving patient outcomes.

Aldosterone antagonists, such as spironolactone or eplerenone, play an important role in reducing morbidity and mortality in patients with HFrEF. They help counteract the detrimental effects of aldosterone, which can lead to fluid retention, increased blood pressure, and further cardiac remodeling. By blocking the action of aldosterone, these medications contribute to improved diuresis, reduced blood volume, and enhanced cardiac function.

In this scenario, since the patient already has high blood pressure, managing hypertension with the use of an aldosterone antagonist can help to address the elevated blood pressure while also providing protective benefits to the heart. This dual action is particularly valuable in the context of heart failure where fluid retention and increased preload can exacerbate symptoms.

While other options provide some level of management, they do not address the underlying issues as effectively as starting an aldosterone antagonist would. For instance, simply increasing the dose of metoprol