What is the first-line pharmacological treatment for dilated cardiomyopathy?

The first-line pharmacological treatment for dilated cardiomyopathy is ACE inhibitors. This class of medications plays a crucial role in managing the condition by promoting vasodilation and reducing afterload, which helps improve cardiac output. ACE inhibitors are particularly beneficial in dilated cardiomyopathy because they address the underlying hemodynamic abnormalities associated with heart failure, such as increased ventricular filling pressures and fluid retention.

These medications also provide additional advantages, including mitigating the progression of heart failure symptoms and improving overall survival rates in patients with this condition. Additionally, ACE inhibitors have neurohormonal modulation properties, which counteract the adverse effects of the renin-angiotensin-aldosterone system that can be activated in heart failure.

Other options, while having their roles in cardiovascular management, do not serve as the first-line treatment for dilated cardiomyopathy specifically. For example, digoxin may be used to manage certain heart failure symptoms but is not typically the primary therapy due to its narrow therapeutic window and potential toxicity. Amlodipine, a calcium channel blocker, is generally avoided in heart failure with reduced ejection fraction as it may not improve mortality. Hydralazine is sometimes used, particularly in specific populations or in combination therapies, but it is not