Comparative Efficacy and Long-Term Outcomes of Beta-Blockers Alone or in Combination With Angiotensin-Converting Enzyme (ACE) Inhibitors in Chronic Heart Failure: A Systematic Review

This systematic review provides a comprehensive comparison of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in the management of chronic heart failure (CHF), with a focus on their long-term efficacy and safety profiles. By synthesizing evidence from randomized controlled trials (RCTs) and clinical studies, the review highlights the significant benefits of both drug classes in reducing mortality and hospital readmissions, and improving patient outcomes. Beta-blockers, such as bisoprolol and carvedilol, demonstrated superior efficacy in reducing sudden cardiac death, particularly in patients with heart failure with reduced ejection fraction (HFrEF). Angiotensin-converting enzyme (ACE) inhibitors, including enalapril and lisinopril, effectively lowered overall cardiovascular mortality by targeting the renin-angiotensin-aldosterone system (RAAS) and preventing further cardiac remodeling. The findings of this review underscore the importance of utilizing these therapies, either alone or in combination, for optimal heart failure management. Combining beta-blockers and ACE inhibitors, or integrating them with newer agents such as angiotensin receptor-neprilysin inhibitors (ARNIs) and mineralocorticoid receptor antagonists (MRAs), provides an additive benefit, improving long-term survival and reducing heart failure-related hospitalizations. The review also identifies gaps in the current literature, suggesting that future research should focus on personalized treatment approaches, longer follow-up periods, and exploring novel therapeutic combinations for diverse heart failure populations. This evidence reinforces the role of beta-blockers and ACE inhibitors as foundational therapies in CHF and offers actionable insights for clinicians to enhance patient care.