Which medication class is used as the first-line treatment for chronic heart failure with reduced ejection fraction?

The first-line treatment for chronic heart failure with reduced ejection fraction primarily involves the use of ACE inhibitors. This medication class plays a critical role in managing heart failure by helping to reduce the workload on the heart and improve cardiac output. ACE inhibitors work by inhibiting the angiotensin-converting enzyme, leading to vasodilation and a resultant decrease in preload and afterload, which can significantly alleviate symptoms and improve exercise tolerance in patients.

Furthermore, ACE inhibitors have been shown to reduce morbidity and mortality in this population. They help in decreasing the progression of heart failure by preventing ventricular remodeling that often occurs in response to chronic pressure overload. The evidence base supporting the use of ACE inhibitors includes several large clinical trials demonstrating their positive effects on heart failure outcomes.

While other medication classes like beta-blockers, diuretics, and aldosterone antagonists are also essential components of heart failure management, they typically are not considered first-line therapy on their own in the context of chronic heart failure with reduced ejection fraction. Beta-blockers are often introduced after ACE inhibitors and are beneficial in further reducing mortality. Diuretics are useful for symptomatic relief of fluid overload but do not improve mortality. Aldosterone antagonists, like spironolactone, are usually added later