American Board Of Family Medicine (ABFM) ITE Practice Test

Blocking the renin-angiotensin-aldosterone system with ACE inhibitors reduces mortality in heart failure with reduced ejection fraction by slowing maladaptive remodeling, lowering afterload, and dampening harmful neurohormonal activation. Large randomized trials like CONSENSUS and SOLVD showed clear survival benefits and fewer hospitalizations with ACE inhibitors in patients with reduced EF. Diuretics help symptoms and fluid management but don’t improve long-term survival. Calcium channel blockers generally do not improve mortality in HFrEF and can be harmful in some cases, while nitrates (without hydralazine) lack broad mortality benefit though the hydralazine–nitrate combo has shown benefit in specific subgroups. Thus, ACE inhibitors have the strongest, widely demonstrated mortality benefit in this population.