Among older patients hospitalized with HFrEF receiving contemporary treatments for HF, initiation of an anti-hypertensive drug was not associated with a lower risk for all-cause mortality or hospital re-admission, according to a study published in The American Journal of Medicine. Phillip Lam, MD, and colleagues examined the association of anti-hypertensive drug initiation and outcomes in patients with HFrEF. In the Medicare linked OPTIMIZE-HF, 7,966 patients with HFrEF (EF ≤40%) without renal failure were not receiving anti-hypertensive drugs before hospitalization, of whom 692 received discharge prescriptions for those drugs (thiazides and calcium channel blockers). The researchers assembled a propensity score-matched cohort of 687 pairs of patients initiated and not initiated on anti-hypertensive drugs, balanced on 38 baseline characteristics. HRs and 95% CIs for outcomes associated with anti-hypertensive drug initiation were estimated in the matched cohort. Participants (N=1,374) had a mean age of 74, 41% were women, 17% were Black, 66% were discharged on renin-angiotensin system inhibitors and beta blockers, and 10% were discharged on aldosterone antagonists. During 6 years of follow-up, 70% of patients died and 53% had a HF readmission. Anti-hypertensive drug initiation was not significantly associated with all-cause mortality (HR, 0.95; 95% CI, 0.83-1.07) or HF readmission (HR, 0.93; 95% CI, 0.80-1.07).