What is the first-line treatment for hypertension in a patient with heart failure?

The first-line treatment for hypertension in a patient with heart failure is ACE inhibitors. This class of medications plays a crucial role in managing heart failure for several reasons. ACE inhibitors help to reduce the workload of the heart by lowering blood pressure, which lessens the strain on the heart muscle. They achieve this by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby promoting vasodilation and decreasing afterload.

In addition to their hypotensive effect, ACE inhibitors have been shown to improve survival outcomes in patients with heart failure with reduced ejection fraction (HFrEF). They also contribute to the reduction of fluid retention, which is a common complication in heart failure patients, thereby improving symptoms such as dyspnea and edema.

While other classes of medications, such as beta-blockers, thiazide diuretics, and calcium channel blockers, can have roles in the management of heart failure or hypertension, they do not replace ACE inhibitors as the first-line treatment in this specific context. Beta-blockers may also be used in heart failure and can help improve heart function and lower heart rate, but they are typically not initiated before ACE inhibitors in cases of hypertension related to heart failure. Thiaz