Which medication class is most important for reducing mortality in congestive heart failure?

• A. Diuretic
• B. ACE inhibitor
• C. Beta-blocker
• D. Digoxin

Answer: (B)

In heart failure with reduced ejection fraction, therapies that block the renin-angiotensin-aldosterone system offer the strongest impact on survival. Blocking the formation of angiotensin II with ACE inhibitors lowers afterload, reduces aldosterone-driven fluid retention, and limits adverse cardiac remodeling. This neurohormonal modulation translates into real, proven reductions in mortality, as demonstrated in major trials like CONSENSUS and SOLVD.

Diuretics mainly relieve symptoms by removing excess fluid but don’t improve survival. Digoxin helps with symptoms and can reduce hospitalizations in some patients but doesn’t improve mortality. Beta-blockers also decrease mortality, but ACE inhibitors are typically the foundational move in reducing deaths because of their broad, early survival benefit across many patients with systolic HF.