Which drug classes are commonly used to reduce mortality in systolic heart failure?

• A. ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists
• B. Calcium channel blockers alone
• C. Vasodilators only
• D. Diuretics for symptom relief only

Answer: (A)

In systolic heart failure, long-term survival improves most with therapies that blunt the bad effects of neurohormonal activation and slow adverse remodeling. ACE inhibitors or ARBs, beta-blockers, and mineralocorticoid receptor antagonists are the mainstays because each targets a key pathway that drives progression and death in this condition. ACE inhibitors or ARBs reduce angiotensin II and aldosterone effects, lowering afterload and preventing remodeling. Beta-blockers dampen excessive sympathetic activity, decrease heart rate and arrhythmia risk, and have shown clear survival benefits. MRAs block aldosterone’s harmful actions, reducing fibrosis and fluid retention, with proven mortality reduction in major trials. By contrast, diuretics mainly relieve symptoms without improving mortality, calcium channel blockers have not shown mortality benefits in this setting, and vasodilators alone do not provide the same survival advantage.