Which medication class is not primarily used to reduce mortality in systolic heart failure?

• A. Calcium channel blockers
• B. ACE inhibitors/ARBs
• C. Beta-blockers
• D. Mineralocorticoid receptor antagonists

Answer: (A)

In systolic heart failure (HFrEF), therapies that have been proven to extend survival work by blocking the harmful neurohormonal processes and remodeling the heart. ACE inhibitors or ARBs, beta-blockers, and mineralocorticoid receptor antagonists all show clear mortality benefits because they counteract the renin-angiotensin-aldosterone system, reduce sympathetic overdrive, and limit fibrotic remodeling. Calcium channel blockers do not provide this survival advantage. In fact, non-dihydropyridine calcium channel blockers can depress heart muscle contractility and may worsen symptoms, while dihydropyridine types have not demonstrated mortality reduction in HF trials and can cause edema. They’re generally used for blood pressure management or angina, not to improve survival in reduced-ejection-fraction heart failure. So the class not used to reduce mortality in systolic heart failure is calcium channel blockers.