Rosh Internal Medicine Boost Practice Exam

Which class of medication is primarily used for managing elevated blood pressure and heart failure by decreasing both heart rate and myocardial contractility?

1. Beta-blockers

2. Diuretics

3. ACE inhibitors

4. Calcium channel blockers

The correct answer is: Beta-blockers

Beta-blockers are primarily used for managing elevated blood pressure and heart failure because they exert their effects by blocking the action of adrenaline on beta-adrenergic receptors in the heart. This action leads to a decrease in heart rate and myocardial contractility, which collectively results in lowered blood pressure and reduced cardiac workload. By slowing down the heart rate, beta-blockers improve the efficiency of the heart, ultimately benefitting patients with heart failure. In this context, while diuretics are useful in heart failure to help reduce fluid overload, they do not directly reduce heart rate or contractility. ACE inhibitors are effective in lowering blood pressure and providing renal protection but do not primarily affect heart rate. Calcium channel blockers can lower blood pressure and are used in various cardiac conditions, but their mechanism involves altered calcium influx rather than directly decreasing heart rate in the same way beta-blockers do. Thus, beta-blockers are the optimal choice for the specific management mentioned in the question.