Which drug class reduces mortality in HF with reduced ejection fraction?

Which drug class reduces mortality in HF with reduced ejection fraction?

• A. ACE inhibitors
• B. Diuretics
• C. Calcium channel blockers
• D. N nitrates

Answer: (A)

In heart failure with reduced ejection fraction, drugs that blunt the harmful neurohormonal effects of the RAAS and remodeling of the heart have been shown to improve survival. ACE inhibitors do this by blocking the formation of angiotensin II, which lowers afterload and preload, reduces vasoconstriction, diminishes aldosterone release, and helps prevent adverse cardiac remodeling. These effects translate into longer survival and fewer hospitalizations for many patients with HFrEF, making ACE inhibitors a foundational mortality-reducing therapy for this condition. Diuretics mainly relieve fluid overload and symptoms by decreasing circulating volume; they improve comfort and activity tolerance but do not shownly reduce mortality. Calcium channel blockers, in general, do not provide mortality benefits in reduced ejection fraction and some can worsen outcomes, so they aren’t considered mortality-reducing therapies in this setting. Nitrates alone don’t reduce mortality either, though the combination of hydralazine with nitrates has shown mortality benefit in specific populations. Among the options, the drug class with proven mortality reduction is ACE inhibitors.

In heart failure with reduced ejection fraction, drugs that blunt the harmful neurohormonal effects of the RAAS and remodeling of the heart have been shown to improve survival. ACE inhibitors do this by blocking the formation of angiotensin II, which lowers afterload and preload, reduces vasoconstriction, diminishes aldosterone release, and helps prevent adverse cardiac remodeling. These effects translate into longer survival and fewer hospitalizations for many patients with HFrEF, making ACE inhibitors a foundational mortality-reducing therapy for this condition.

Diuretics mainly relieve fluid overload and symptoms by decreasing circulating volume; they improve comfort and activity tolerance but do not shownly reduce mortality. Calcium channel blockers, in general, do not provide mortality benefits in reduced ejection fraction and some can worsen outcomes, so they aren’t considered mortality-reducing therapies in this setting. Nitrates alone don’t reduce mortality either, though the combination of hydralazine with nitrates has shown mortality benefit in specific populations. Among the options, the drug class with proven mortality reduction is ACE inhibitors.