Heart Failure USMLE Step 1 Practice Question

A 68-year-old man with a 10-year history of hypertension presents to the emergency department with progressive dyspnea on exertion and orthopnea over 3 weeks. His wife reports he has been unable to climb stairs and awakens at night gasping for air. Vital signs: BP 158/92 mmHg, HR 102/min, RR 22/min, SpO2 94% on room air. Physical examination reveals elevated jugular venous pressure (8 cm H2O), a laterally displaced point of maximal impulse, an S3 gallop, bibasal crackles, and bilateral pitting ankle edema. Chest X-ray shows pulmonary edema with Kerley B lines. Transthoracic echocardiography reveals a left ventricular ejection fraction of 28% with global hypokinesis. Brain natriuretic peptide is 485 pg/mL. Troponin is negative. He denies recent chest pain and has no significant coronary risk factors beyond hypertension. Which of the following medications has been shown to reduce mortality in patients with reduced ejection fraction heart failure?