Which class of medications should be avoided in patients with heart failure to prevent fluid retention?

Calcium channel blockers should be approached with caution in patients with heart failure due to their potential to cause fluid retention and worsening heart failure symptoms. These medications, particularly the non-dihydropyridine agents such as diltiazem and verapamil, can reduce myocardial contractility and may lead to edema.

In contrast, beta-blockers and aldosterone antagonists are generally beneficial in heart failure management. Beta-blockers can improve cardiac function and reduce mortality by decreasing heart rate and managing arrhythmias. Aldosterone antagonists are particularly useful for their ability to block sodium retention, helping to manage fluid balance in patients with heart failure. Sodium channel blockers do not have a direct impact on fluid retention in this context.

Thus, the concern with calcium channel blockers is their potential to exacerbate heart failure symptoms due to fluid retention, making them a class to avoid in these patients.