A 58-year-old man presents to your office with progressive dyspnea over the last three months. Previously, he had been able to work in his farm and take care of his cows, but now he feels short of breath after walking only 50 feet. He does not have chest pain at rest but has experienced retrosternal chest pressure with strenuous work. His sleep is also not ‘peaceful’ because he wakes up at night feeling short of breath, which is relieved within minutes by sitting upright in bed. On physical examination, he is afebrile, with a heart rate of 88 beats per minute (bpm), blood pressure of 145/92 mm Hg, and respiratory rate of 18 breaths per minute. On cardiac examination, his heart rhythm is regular with a normal S1 and S2 with a systolic murmur loudest over the second right intercostal space. He also has elevated jugular venous pressure (JVP), pedal edema and bilateral crackles in lungs. Echocardiogram reveals an ejection fraction of 30% and aortic stenosis. Which of the following medications is shown to improve long-term survival in this patient?
