What Medications Are Used to Treat Heart Failure?

Heart failure (HF) is managed with lifestyle changes and treated with a combination of medications.^1-2 Medications may be prescribed to treat the underlying causes of HF as well as other medical conditions you may have.³ Treatments for multiple conditions may interfere with each other and can be a challenge for both the healthcare provider and the patient. In addition, some people find that they have to take multiple drugs to treat the same condition.

The goal of treatment is to control the symptoms of heart failure, help you live longer and stay out of the hospital. This may require multiple medications to manage your specific symptoms.^2-3

Heart failure medications are proven to help you live longer, feel better and keep you out of the hospital. By making it easier to breathe and reducing the swelling you may have more energy, be more active, and live longer.³ It is important to let your provider know what medications, vitamins, supplements, and over-the-counter drugs you currently take for your heart and any other medical conditions. Some drugs used to treat heart failure can have an interaction with medications you already take. It is important for your provider and pharmacist to have all this information before starting you on a medication regimen.

Heart failure medications

There are many medicines used specifically to treat heart failure. There have been many studies conducted to determine the best medications and dosages for treatment of systolic heart failure. These are called guideline directed medications. The exact medications that you will be prescribed will depend on the type and stage of your heart failure. The different medications are aimed at different systems in your body to completely treat your heart failure and decrease your symptoms. Some commonly prescribed medications include:^1-3

• ACE (angiotensin-converting enzyme) inhibitors
• ARBs (angiotensin receptor blockers)
• Angiotensin-Receptor Neprilysin Inhibitors (ARNIs)
• Beta-blockers
• Aldosterone antagonists
• Diuretics (water pills)
• Hydralazine and Isosorbide dinitrate (BiDil)
• Digoxin
• Ivabradine

Many drug companies make heart failure medications. Every medication has a generic name and a brand name. There can be many different drugs in each class above.¹

ACE inhibitors

Ace inhibitors are vasodilators, drugs that lower blood pressure by widening blood vessels which improve blood flow and reduce how hard the heart has to work.² They also block the effects of harmful stress hormones that come from the kidneys.³ They have been proven to limit or reverse damage to the heart.

ARBs

Angiotensin II receptor blockers, work similarly to ACE inhibitors and provide similar benefits.^2-3 Sometimes prescribed for people who can't tolerate ACE inhibitors (due to a cough), ARB medicines reduce the impact of certain harmful stress hormones that come from the kidneys. Like ACE inhibitors, they have been proven to limit or reverse damage to the heart.

ARNIs

Angiotensin-receptor neprilysin inhibitors are a newer drug combination used in the treatment of HF. It is a combination of a neprilysin inhibitor and an ARB. The ARB causes blood vessels to widen (vasodilation), leading to a reduction in blood pressure. Neprilysin inhibition causes an increase in levels of natriuretic peptides which help maintain fluid and sodium balance. This, in turn, helps to reduce blood pressure and eliminates excess fluid. They help reduce the risk of complications of systolic heart failure, help people live longer and reduce damage to the heart.²

Beta-blockers

Beta-blockers are also known as beta-adrenergic blocking agents, slow the heart rate and reduce blood pressure. It is often prescribed for people with systolic heart failure to limit or reverse some heart damage.² Beta-blockers also reduce the effects of harmful stress hormones and can reduce the chance of developing some arrhythmias and lessening the likelihood of sudden death.³

Aldosterone antagonists

Aldosterone antagonists are potassium-sparing diuretics.² They block the effects of the stress hormone aldosterone. They help prevent the kidneys from eliminating too much potassium from the body when taking stronger diuretics.³ They also benefit people with severe systolic heart failure, helping them to live longer.²

Diuretics

Diuretics, also called water pills, work by signaling the body to eliminate excess fluid and sodium through the urine. Reduced fluid volume can reduce swelling and congestion making it easier to breathe.^2-3 Diuretics reduce the work effort required by the heart. There are multiple kinds of diuretics that work in different ways and at different rates.¹

Isosorbide dinitrate and hydralazine are vasodilator

Isosorbide dinitrate and hydralazine are vasodilator medications that cause blood vessels to dilate (relax and widen) thus reducing the work of the heart and improving blood flow.³ It is noted to specifically benefit African-Americans with heart failure.²

Digoxin

Digoxin is also referred to as digitalis, improves the strength of heart muscle contractions. This may improve heart function by enabling a stronger heartbeat and correcting hormonal imbalance.³ It also tends to slow the heartbeat and improve symptoms in people with systolic heart failure. It is often prescribed for people with heart rhythm problems like atrial fibrillation.²

Specific medications and dosages may be adjusted by your healthcare team after initial treatment begins.³ This is normal; your provider will want you to feel better quickly and to improve your overall health. This may require trying and taking multiple medications for treating the same condition. Some of the medications work best at higher doses, so you may be seen frequently to increase the doses safely.

In addition to medications prescribed to manage heart failure, there may be contributing cardiac conditions that require additional pharmaceutical treatment. For example, your doctor may prescribe a statin if you have high cholesterol, or a blood thinner (anti-coagulant) if you suffer from atrial fibrillation.¹

SGLT2 inhibitors

SGLT2 (sodium-glucose cotransporter-2) inhibitors are medications often taken by people with type 2 diabetes to help lower blood sugar. There is now evidence showing these drugs (for example, Farxiga) can reduce the risk of major cardiac events in people with HFrEF.³

Side effects

Medications frequently have side effects. Tell your doctor about the symptoms you are feeling from the medication. They may need to adjust the dosage or timing of the medications to ease the problems.³

Medication adherence

Keep track of all medications. Make a list of everything you take including the dosage and frequency. Make sure to update it each time you have a change in prescribed medication or over-the-counter products including vitamins and supplements. Keep it in a convenient place at home and keep a copy in your wallet or purse so you have it available at all medical visits.³

Be sure to follow the instructions and take all medicines as prescribed.³ Do not stop taking your medications even if you are feeling better.³ Report any sudden change in the way you feel or symptoms you experience to your healthcare team.