For chronic congestive heart failure, which medication combination is commonly used?

• A. Calcium Channel Blocker Plus ACE Inhibitor
• B. Diuretic Plus ACE Inhibitor
• C. ACE Inhibitors or ARBs Plus Beta-Blocker
• D. Beta-Blocker Alone

Answer: (C)

In chronic heart failure with reduced ejection fraction, addressing the two main hormonal drivers of progression—the renin-angiotensin-aldosterone system and the sympathetic nervous system—significantly improves survival and reduces hospitalizations. An ACE inhibitor (or an ARB if ACE inhibitors are not tolerated) lowers afterload and preload and helps prevent remodeling, while a beta-blocker counters the harmful effects of chronic sympathetic activation on the heart. Used together, they provide a mortality and morbidity benefit that isn’t achieved by many other single agents. Diuretics may relieve symptoms from fluid overload, but they don’t carry the same impact on long-term outcomes. Calcium channel blockers are not preferred in systolic HF due to potential negative inotropic effects and lack of survival benefit, and a beta-blocker alone doesn’t address the RAAS activation driving disease.