Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or other changes that may further weaken or stiffen the heart. Drug treatment of heart failure involves
The type of drug used depends on the type of heart failure. In systolic heart failure (heart failure with reduced ejection fraction, HFrEF), all drug classes helpful. In diastolic heart failure (heart failure with preserved ejection fraction, HFpEF), only ACE inhibitors, ARBs, aldosterone antagonists, beta-blockers, and SGLT2 inhibitors are typically used. In heart failure with mildly reduced ejection fraction (HFmrEF), ARNIs, and SGLT2 inhibitors may be helpful.
It is important for people to take their drugs regularly and be sure not to let the prescription run out.
Aldosterone antagonists
Aldosterone is a hormone that causes the kidneys to retain salt and water. Thus, aldosterone antagonists (blockers) directly block the effects of aldosterone (unlike ACE inhibitors which block it indirectly) and help limit fluid retention. These drugs improve survival and reduce hospitalization in people with heart failure.
Angiotensin-converting enzyme (ACE) inhibitors
vasopressinRegulating Blood Pressure: The Renin-Angiotensin-Aldosterone System). By doing so, ACE inhibitors cause arteries and veins to widen (dilate) and help the kidneys excrete excess water, thus decreasing the amount of work the heart has to do. These drugs also may have direct beneficial effects on the heart and blood vessel walls.
Angiotensin II receptor blockers (ARBs)
Angiotensin receptor/neprilysin inhibitors
Angiotensin receptor/neprilysin inhibitors (ARNIs) are a newer combination drug for the treatment of heart failure. They include an ARB and a new class of drug, neprilysin inhibitors. Neprilysin is an enzyme involved in the breakdown of certain substances (peptides) that signal the body to excrete sodium. By inhibiting the breakdown of these peptides, these drugs lower blood pressure and increase sodium excretion, lowering the heart's workload. The drugs prolong life better than ACE inhibitors or ARBs alone in people with systolic heart failure.
Beta-blockers
Beta-blockers are often used with ACE inhibitors to treat heart failure and are another mainstay of heart failure treatment. These drugs block the action of the hormone norepinephrine (which increases stress on the heart) and produce long-term improvement in heart function and survival and are an essential treatment in people with systolic heart failure. Beta-blockers may reduce the force of the heart’s contractions initially, so they are usually introduced after heart failure has first been stabilized with other drugs.
Digoxin
Diuretics
Diuretics ("water pills") are often prescribed when salt restriction alone does not reduce fluid retention. These drugs help the kidneys eliminate salt and water by increasing urine formation and thus decreasing fluid volume throughout the body.
Loop diuretics,
Thiazide diuretics,
Loop and thiazide diuretics can cause potassium to be lost in the urine, resulting in hypokalemia
Taking diuretics can worsen urinary incontinence. However, a dose of a diuretic can usually be timed so that the risk of incontinence does not occur when a bathroom is unavailable or when access to one is inconvenient.
Sinus node inhibitors
Sodium-glucose cotransporter-2 inhibitors (SGLT2s)
Vasodilators
Other drugs used for heart failure
Other drugs are sometimes helpful.
If the heart rhythm is abnormal, antiarrhythmic drugs (see table Some Drugs Used to Treat Arrhythmias) may be given.
Some Drugs Used to Treat Heart Failure
Drug | Comments* |
|---|---|
Aldosterone antagonists | |
These drugs block the action of the hormone aldosterone, which promotes salt and fluid retention and may have direct adverse effects on the heart. Both are potassium-sparing diuretics and improve survival and reduce hospitalizations. | |
Angiotensin-converting enzyme (ACE) inhibitors | |
ACE inhibitors cause blood vessels to widen (dilate), thus decreasing the amount of work the heart has to do. They may also have direct beneficial effects on the heart. These drugs are the mainstay of heart failure treatment. They reduce symptoms and the need for hospitalization, and they prolong life. | |
They may be used in people who cannot take an ACE inhibitor. | |
Angiotensin receptor/neprilysin inhibitor | |
The combination drug may be given to people who have systolic heart failure with mild or moderate symptoms. In these people, this combination drug prolongs life better than an ACE inhibitor used alone. | |
Beta-blockers | |
Beta-blockers slow the heart rate and block excessive stimulation of the heart. These drugs are usually used with ACE inhibitors and provide an added benefit. They may temporarily worsen symptoms but result in long-term improvement in heart function. | |
Cardiac glycoside | |
Guanylate cyclase stimulator | |
Causes widening of the artery transporting blood from the right side of the heart to the lungs | |
Loop diuretics | |
These diuretics help the kidneys eliminate salt and water, thus decreasing the volume of fluid in the bloodstream. | |
Potassium-sparing diuretics | |
Because these diuretics prevent potassium loss, they may be given in addition to thiazide or loop diuretics, which cause potassium to be lost. | |
Sinus node inhibitor | |
Sodium-glucose cotransporter-2 inhibitors | These drugs for diabetes also have beneficial effects in heart failure whether or not people have diabetes |
Typically are not used in people who have low blood pressure or poor kidney function | |
Typically are not used in people who have low blood pressure or poor kidney function | |
Thiazide and thiazide-like diuretics | |
The effects of these diuretics are similar to loop diuretics. The two types of diuretics are particularly effective when used together. | |
Opioid | |
Careful supervision is necessary. | |
Vasodilators | |
Vasodilators cause blood vessels to dilate. | |
