What should be avoided in stage C hypertension patients with low ejection fraction?

In patients with stage C hypertension and low ejection fraction, it is important to manage blood pressure while also addressing the underlying heart failure. Non-dihydropyridine calcium channel blockers, such as verapamil and diltiazem, can be problematic in this population. They are known to have a negative inotropic effect, meaning they can decrease the strength of the heart's contraction. This decrease in contractility can worsen heart failure symptoms and potentially lead to adverse outcomes.

In contrast, diuretics are often utilized to manage fluid overload, which is a common issue in patients with heart failure. Beta blockers, despite being contraindicated in acute decompensated heart failure, are beneficial in chronic heart failure with reduced ejection fraction as they help to decrease heart rate, improve ventricular function, and have a mortality benefit long-term. Additionally, ACE inhibitors are a cornerstone of heart failure therapy, providing benefits such as vasodilation and reducing the workload on the heart, while also improving survival rates.

Therefore, non-dihydropyridine calcium channel blockers should be avoided in stage C hypertension patients with low ejection fraction due to their potential to exacerbate heart failure symptoms and negatively impact cardiac function.