Given a normal ejection fraction of 62%, a treadmill test METs of 20.5, nocturnal heart rate of 50‑55 bpm, and no hypertension or diabetes, do I need lifelong beta‑blocker or angiotensin‑converting enzyme inhibitor therapy?

No, You Do Not Need Lifelong Beta-Blockers or ACE Inhibitors

Based on your excellent cardiac function (EF 62%), exceptional exercise capacity (METs 20.5), and absence of hypertension, diabetes, or chronic kidney disease, you do not require lifelong beta-blocker or ACE inhibitor therapy.

Why These Medications Are Not Indicated for You

Beta-Blockers: Not Recommended

The most recent 2023 AHA/ACC Chronic Coronary Disease guidelines represent a major shift from older recommendations 1:

• In patients with normal left ventricular function (EF >50%) without recent myocardial infarction, beta-blockers provide no benefit in reducing major adverse cardiovascular events 1
• Your EF of 62% places you well above the threshold where beta-blockers show mortality benefit
• The 2023 guidelines specifically state that long-term beta-blocker therapy is not recommended (Class 3: No Benefit) for patients like you without: prior MI in the past year, EF ≤50%, or another primary indication (hypertension, arrhythmias, angina) 2, 1

Recent research strongly supports this position:

• The 2025 individual-patient data meta-analysis of 17,801 patients confirmed no prognostic benefit from beta-blockers in patients with preserved EF 3
• The REDUCE-AMI trial showed no benefit in patients with EF ≥50% 3

Your resting heart rate of 50-55 bpm during sleep is physiologically normal for someone with your exceptional fitness level (METs 20.5). This reflects excellent cardiovascular conditioning, not a need for rate control.

ACE Inhibitors: Not Indicated

According to AHA/ACC guidelines, ACE inhibitors have Class I (mandatory) indications only for 4:

• Left ventricular EF <40% (you have 62%)
• Hypertension (you don't have this)
• Diabetes mellitus (you don't have this)
• Chronic kidney disease (you don't have this)

For patients like you—lower-risk with normal EF and well-controlled cardiovascular risk factors—ACE inhibitors are considered optional (Class IIa) at best 5, 6, 5, 6. The 2006 guidelines specifically state: "Among lower-risk patients with normal left ventricular ejection fraction in whom cardiovascular risk factors are well controlled and revascularization has been performed, use of ACE inhibitors may be considered optional" 5, 6.

What You Should Focus On Instead

Your exceptional METs score of 20.5 indicates you are in the top tier of cardiovascular fitness. The guidelines emphasize:

1. Continue your current physical activity - This is providing tremendous cardiovascular protection 1
2. Maintain healthy dietary habits 1
3. Monitor for development of hypertension or diabetes - These would change the recommendation
4. Consider statin therapy if you have any coronary disease (not clear from your question) 1

Important Caveats

This recommendation assumes:

• You have no history of myocardial infarction
• You have no coronary artery disease requiring treatment
• You have no angina or ischemic symptoms
• You have no arrhythmias (like atrial fibrillation)
• Your blood pressure remains normal without medication

If any of these conditions are present, the recommendations would change significantly.

The Bottom Line

Your excellent cardiac function, outstanding exercise capacity, and absence of traditional cardiovascular risk factors mean you fall into the lowest-risk category where neither beta-blockers nor ACE inhibitors have demonstrated benefit for reducing mortality or cardiovascular events. The most recent evidence strongly supports not using these medications in your situation 2, 1, 3.