What is the first-line pharmacological treatment for heart failure?

• A. ACE inhibitors
• B. Beta-blockers
• C. Diuretics
• D. Nitrates

Answer: (C)

Relief of fluid overload is the immediate goal in heart failure, and diuretics provide the fastest, most reliable symptom relief. Loop diuretics such as furosemide act on the thick ascending limb of the loop of Henle to block Na-K-2Cl reabsorption, leading to increased excretion of sodium, chloride, and water. This reduces preload and pulmonary and peripheral edema, quickly improving dyspnea and swelling. Because congestion is a hallmark of many heart failure patients, diuretics are typically started to relieve symptoms promptly, both in acute decompensation and in chronic management when there is fluid retention.

Beyond symptom relief, other drugs have important roles but address different goals. ACE inhibitors or ARBs and beta-blockers improve long-term outcomes and mortality in heart failure with reduced ejection fraction, but they are not the immediate first-step treatment for congestion. Nitrates lack the broad role in heart failure management that diuretics provide for rapid relief of volume overload.