What drug class reduces mortality in systolic heart failure by blocking the renin-angiotensin-aldosterone system (RAAS)?

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Multiple Choice

What drug class reduces mortality in systolic heart failure by blocking the renin-angiotensin-aldosterone system (RAAS)?

Blocking the RAAS helps in systolic heart failure by dampening the harmful long‑term effects of angiotensin II and aldosterone, which drive vasoconstriction, fluid retention, and adverse remodeling of the heart. ACE inhibitors do this by preventing the conversion of angiotensin I to angiotensin II, lowering angiotensin II and aldosterone levels. The result is vasodilation, reduced preload and afterload, and less structural damage to the heart, which translates into improved survival. ARBs achieve similar benefits by blocking the angiotensin II receptor, and they’re often used when ACE inhibitors aren’t tolerated (for example, due to cough or angioedema). Because of this mortality benefit, ACE inhibitors are considered classic first‑line therapy for reducing mortality in systolic heart failure. Diuretics mainly relieve symptoms by removing excess fluid and don’t reliably improve survival. Beta blockers also reduce mortality but do so by a different mechanism—blunting sympathetic activation—rather than RAAS blockade. Calcium channel blockers, in general, do not improve survival in systolic HF and can be harmful in some cases.

Blocking the RAAS helps in systolic heart failure by dampening the harmful long‑term effects of angiotensin II and aldosterone, which drive vasoconstriction, fluid retention, and adverse remodeling of the heart. ACE inhibitors do this by preventing the conversion of angiotensin I to angiotensin II, lowering angiotensin II and aldosterone levels. The result is vasodilation, reduced preload and afterload, and less structural damage to the heart, which translates into improved survival. ARBs achieve similar benefits by blocking the angiotensin II receptor, and they’re often used when ACE inhibitors aren’t tolerated (for example, due to cough or angioedema). Because of this mortality benefit, ACE inhibitors are considered classic first‑line therapy for reducing mortality in systolic heart failure. Diuretics mainly relieve symptoms by removing excess fluid and don’t reliably improve survival. Beta blockers also reduce mortality but do so by a different mechanism—blunting sympathetic activation—rather than RAAS blockade. Calcium channel blockers, in general, do not improve survival in systolic HF and can be harmful in some cases.

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