Neurohormonal blockade includes which of the following classes?

• A. Beta blockers
• B. ACE inhibitors
• C. MRAs
• D. All of the above

Answer: (D)

Neurohormonal blockade targets the maladaptive activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system that drives progression in heart failure. Beta blockers blunt chronic sympathetic stimulation, lowering heart rate and myocardial oxygen demand and reducing renin release. ACE inhibitors block the formation of angiotensin II, leading to vasodilation, reduced aldosterone-mediated fluid retention, and favorable remodeling. Mineralocorticoid receptor antagonists directly block aldosterone’s effects, providing additional diuretic and antifibrotic benefits. Because each therapy tackles a different part of the same harmful neurohormonal cascade, all three are considered neurohormonal blockade. So the best answer is that all of these classes are included.

In practice, these are used together when appropriate, with monitoring for side effects like hyperkalemia or kidney function changes with MRAs and ACE inhibitors, and careful titration of beta blockers.