In systolic heart failure, which class of drug has been shown to improve survival?

• A. Calcium channel blockers
• B. Beta blockers
• C. Loop diuretics
• D. ACE inhibitors

Answer: (D)

Blockade of the renin-angiotensin-aldosterone system in systolic heart failure interrupts a cycle that drives worsening remodeling and higher mortality. ACE inhibitors reduce angiotensin II and aldosterone, which lowers afterload and preload and slows adverse cardiac remodeling. This combination of hemodynamic relief and long-term structural benefit has been shown to improve survival in major randomized trials of heart failure patients, making ACE inhibitors the class with the strongest evidence for mortality reduction. Loop diuretics improve symptoms by unloading the heart but haven’t demonstrated a survival benefit; calcium channel blockers can depress contractility and lack proven mortality benefit in systolic HF; beta blockers do improve survival in stable chronic HF, but the most consistently demonstrated mortality reduction in this setting comes from ACE inhibitors.