Medications for Heart Failure

Heart failure (HF) is managed with a combination of lifestyle changes and medicines. Some medicines may treat underlying causes of HF. Or they may treat other medical conditions that affect the health of your heart. Some people may need to take several drugs to treat multiple symptoms or risk factors.¹

HF drugs

The goals of HF treatment are to control symptoms, help you live longer, and reduce the frequency and length of hospital stays. 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 in different ways to improve symptoms. Common groups or types of drug (classes) include:^1,3-7

• Aldosterone antagonists
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)
• Angiotensin receptor-neprilysin inhibitors (ARNIs)
• Anticoagulants
• Beta-blockers
• Digoxin
• Diuretics
• Glucagon-like peptide-1 (GLP-1) agonists
• Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers
• Isosorbide dinitrate/hydralazine
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors
• Soluble guanylate cyclase (sGC) stimulators

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.¹

Aldosterone antagonists, ACE inhibitors, ARBs, and ARNIs work on your body’s renin-angiotension-aldosterone system (RAAS), which responds to stress and helps your body prepare for fight or flight by increasing your blood pressure and retaining fluid to improve circulation.^1,2

RAAS plays a major role in heart failure. As the failing heart becomes unable to meet the blood flow demands of vital organs, RAAS will activate in an attempt to increase circulation. However, this places an increased burden on the heart, causing it to fail even faster.^1,2

Aldosterone antagonists (mineralocorticoid receptor antagonists)

Aldosterone antagonists are diuretics. 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 drugs prevent the kidneys from eliminating too much potassium. They are commonly referred to as “potassium-sparing diuretics.” Maintaining an appropriate level of potassium is important for the heart to function normally.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 widen your blood vessels, which improves blood flow and reduces how hard your heart has to work. ACE inhibitors also block the effects of harmful stress hormones.^1,3

ARBs

Angiotensin receptor blockers (ARBs) also lower your blood pressure. They provide similar benefits to ACE inhibitors. ARBs are sometimes prescribed for people who cannot tolerate ACE inhibitors. ARBs work by blocking the effect of angiotensin II in the heart, blood vessels, and kidneys.^1,3

ARNIs

Angiotensin receptor-neprilysin inhibitors (ARNIs) combine an ARB with a neprilysin inhibitor. Neprilysin is an enzyme in the body that breaks down chemical messengers that open arteries. So blocking neprilysin improves artery opening and blood flow. ARNIs reduce strain on the heart.¹

Anticoagulants

Anticoagulants are also known as blood thinners. They reduce the ability of blood to clot. Anticoagulants can prevent clots from growing and causing serious problems. People with HF are at increased risk of conditions like atrial fibrillation, which increases the risk of stroke. Anticoagulants may be prescribed for people with HF and atrial fibrillation.⁵

Beta-blockers

Beta-blockers are also known as beta-adrenergic blocking agents. They slow the heart rate, which gives the heart more time to recover after each beat, reduces blood pressure, and regulates heart rhythm. They also reduce the effects of harmful stress hormones. This reduces the workload of the heart and helps it pump better.^1,3

Digoxin

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. Because this drug is difficult to manage and may have a variety of side effects, 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. This reduces fluid buildup in the lungs, making it easier to breathe. Diuretics also reduce 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

GLP-1 agonists

Glucagon-like peptide-1 (GLP-1) receptor agonists are used to treat type 2 diabetes. They work by reducing blood sugar levels. GLP-1 agonists also reduce risk factors for HF. They promote weight loss, reduce inflammation, and lower blood pressure. They also directly act on heart muscle cells to protect heart function. GLP-1 receptor agonists may help people with new-onset HF and reduce symptoms for HF with preserved ejection fraction. However, they may have neutral or even negative effects in people with established HF with reduced ejection fraction.^6,8

HCN channel blockers

Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers slow your heartbeat. They block an electrical current to slow down the pace of your heartbeat. HCN channel blockers help your heart pump more blood with each beat. They are also able to slow the heart rate without decreasing blood pressure.¹

SGLT2 inhibitors

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are often taken by people with type 2 diabetes. SGLT2 inhibitors lower blood sugar by increasing the amount of glucose released in urine. Clinical trials have shown that these drugs also help people with HF due to their diuretic effect. SGLT2 inhibitors reduce the risk of major cardiac events and death.¹

Isosorbide dinitrate/hydralazine

Isosorbide dinitrate and hydralazine are 2 drugs that widen blood vessels. This improves blood flow and reduces the workload of the heart. They may be given as separate drugs or combined in a single pill. Your doctor may prescribe them along with ACE inhibitors and ARBs.^1,3

Isosorbide dinitrate works by being converted in the body to nitric oxide (NO) and activating the NO-sCG-cGMP pathway, which is the body’s way of telling blood vessels to expand.^9,10

sGC stimulators

Soluble guanylate cyclase (sGC) stimulators reduce the stiffness of heart cells and blood vessels. They work on the same pathway that isosorbide dinitrate does, but at a different step in the process. They increase the formation of cyclic guanosine monophosphate (cGMP). cGMP protects the heart by relaxing blood vessels and heart cells. Certain sGCs may prevent hospitalization for people with severe HF, when combined with other HF drugs.⁷

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. Keep a physical copy in your wallet or purse and a digital copy in your phone.¹

Take your medicines as your doctor prescribes. Do not stop taking your medicines even if you feel better. Tell your doctor about any 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 HF treatment, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.