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. 2023 Oct 12;12(20):6486. doi: 10.3390/jcm12206486

Figure 4.

Figure 4

Implementation of medical treatment in hypertensive heart failure (HHF). The presence of elevated blood pressure (BP) in HHF as well as the renoprotective effects of finerenone, which rarely causes early hyperkalemia, allows ultra-fast up-titration of HF medications. Treatment should start with the simultaneous use of sacubitril/valsartan, sodium glucose cotransporter 2 inhibitors (SGLT-2i), and mineralocorticoid receptor antagonists (MRAs, preferably finerenone). In HHF patients with eccentric left ventricular hypertrophy (LVH), β-blockers (preferably vasodilatory) should be started from the beginning, whereas in HHF patients with concentric LVH, β-blockers should be considered in those with atrial fibrillation, coronary artery disease, or resistant hypertension. A target systolic BP of 110–130 mmHg should be achieved within 45 days, and thereafter, systolic BP should remain within the therapeutic target range most of the time. TTR, Time in Therapeutic Range. With permission from ref. [13].