Medications for Heart Failure

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

Heart failure (HF) is managed with a combination of lifestyle changes and medicines. Medicines may treat underlying causes of HF or other medical conditions. Medicines for multiple conditions may interfere with each other. Some people may also take multiple drugs to treat the same condition.1

Heart failure medications

The goals of HF treatment are to control symptoms, help you live longer, and reduce hospital stays. Some people with HF need several medicines to achieve this. Studies have shown that HF drugs can:1,2

  • Reduce fatigue
  • Reduce shortness of breath and swelling
  • Improve energy level
  • Stop or slow the progression of HF
  • Increase life expectancy and quality of life

Many medicines are used to treat HF. The best medicines for you depend on personal factors, including your type and stage of HF. Different medicines work on different systems in your body to improve symptoms. Some commonly prescribed medications include:1,3,4

  • Aldosterone antagonists
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Angiotensin receptor-neprilysin inhibitors (ARNIs)
  • Beta-blockers
  • Digoxin
  • Diuretics
  •  Isosorbide dinitrate/hydralazine
  • Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers
  • SGLT2 Inhibitors

These are not all the drugs used to treat HF. Your doctor may suggest other medicines depending on your side effects or other medical conditions. For example, your doctor may prescribe a statin for high cholesterol or a blood thinner for some abnormal heart rhythms, like atrial fibrillation.1

Aldosterone antagonists (mineralocorticoid receptor antagonists)

Aldosterone antagonists are a type of diuretic. They block the effects of the stress hormone, aldosterone. Blocking aldosterone allows the kidneys to get rid of extra water and sodium. This lowers blood pressure and reduces fluid build-up. Unlike other diuretics, these prevent the kidneys from eliminating too much potassium, which is important for the heart.3

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure. They work by preventing an enzyme in the body from making a hormone called angiotensin II. This helps to widen your blood vessels, improving blood flow and reducing how hard your heart has to work. They also block the effects of harmful stress hormones.1,3


Angiotensin receptor blockers (ARBs) also lower your blood pressure. They provide similar benefits as ACE inhibitors. These work by blocking certain receptors in the body, which lowers blood pressure. They are sometimes prescribed for people who cannot tolerate ACE inhibitors.1,3


Angiotensin receptor-neprilysin inhibitors (ARNIs) combine an ARB with a neprilysin inhibitor. Neprilysin is an enzyme that breaks down substances that open arteries. Blocking neprilysin improves artery opening and blood flow. ARNIs work to reduce strain on the heart.1


Beta-blockers are also known as beta-adrenergic blocking agents. They slow the heart rate, reduce blood pressure, and regulate your heart rhythm. They reduce the effects of harmful stress hormones. This reduces the workload of the heart and helps it pump better.1,3


Digoxin improves the strength of heart muscle pumping. This may improve heart function by enabling a stronger heartbeat. Digoxin also slows the heartbeat, especially for people with HF and atrial fibrillation. It is usually used for people who still have HF symptoms after trying other drugs.1,3

Diuretics (water pills)

Diuretics help the body get rid of extra fluid and sodium through urine. The reduces fluid buildup in the lungs, making it easier to breathe. It also reduces fluid in the bloodstream, allowing the heart to pump more easily and decreasing blood pressure. Different diuretics work in different ways and at different speeds.1,3

HCN channel blockers

Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers slow your heartbeat. They block an electrical current that regulates the pace of your heartbeat.  By lowering your resting heart rate, HCN channel blockers help your heart pump more blood with each beat.1

Isosorbide dinitrate/hydralazine

Isosorbide dinitrate and hydralazine cause blood vessels to widen. This improves blood flow and reduces the workload of the heart. They may be given as separate drugs or combined in a single pill. They may be used with ACE inhibitors and ARBs or used alone.1,3

SGLT2 inhibitors

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are often taken by people with type 2 diabetes. SGLT-2 inhibitors lower blood sugar by increasing the release of glucose in urine. Clinical trials have shown that they also help in HF. SGLT-2 inhibitors reduce the risk of major cardiac events and death.1

Things to consider

Keep track of all of your medicines. Make a list of everything you take, including the dosage and frequency. Update it whenever your medicine or dosage changes. Keep the list in a convenient place at home. Also keep a copy in your wallet or purse.1

Take your medicines as your doctor prescribes. Do not stop taking your medicines even if you feel better. Tell your doctor about sudden change in symptoms. Your doctor may adjust your medicine and dosage after initial treatment. This will help find the best treatment to improve your overall health.1

Before beginning treatment for heart failure, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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