Heart failure medications: 6 types
Most heart failure therapies involve a combination of different medications that target specific symptoms.
It’s important to take heart failure medication as prescribed. There are various classes of heart failure medications, each with a unique mechanism of action and possible side effects.
ACE inhibitors are medications that inhibit the conversion of a hormone called angiotensin I to angiotensin II. This results in the relaxation of the blood vessels, which means the heart muscles don’t have to work as hard.
Most doctors include ACE inhibitors in combination therapy for heart failure because of their efficacy. They may start ACE inhibitors at a low dose while monitoring your reaction to the medication.
Common examples of ACE inhibitor drugs include:
ACE inhibitors may have the following side effects:
- recurrent dry cough
- hypersensitivity reactions, such as swelling
To make sure your body can tolerate ACE inhibitors, a doctor may monitor your blood pressure, potassium levels, and kidney function.
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Angiotensin receptor blockers
Angiotensin receptor blockers (ARBs) work by blocking binding angiotensin II to its receptor, which inhibits the renin-angiotensin-aldosterone system (RAAS).
By inhibiting the RAAS pathway, the drug prevents the release of the hormone aldosterone and relaxes the blood vessels. This results in a decreased workload on the heart muscles.
Doctors prescribe ARBs to people who can’t tolerate ACE inhibitors due to a distressing cough or hypersensitivity reactions.
Common examples of ARBs are:
Possible side effects of ARBs include:
- hypotension (low blood pressure)
- kidney problems
- high potassium levels in the blood
Doctors will prescribe ARBs with caution when the person has heart failure and low blood pressure or narrow arteries in their kidneys (also known as bilateral renal artery stenosis or constriction).
Beta-blockers that selectively block beta-1 receptors in the heart muscle are effective in heart failure therapy. Beta-1 receptor blockage reduces the heart’s demand for oxygen and has heart-protective benefits.
Common examples of beta-blockers doctors use for heart failure include:
Common side effects of beta-blockers may include:
- decreased heart rate
- low blood pressure
- fluid retention
Doctors usually prefer to start beta-blockers at a low dose and monitor your heart rate and blood pressure.
Diuretics are medications that reduce fluid retention associated with heart failure.
They work by preventing sodium chloride from being reabsorbed in the kidney tubes. Diuretics help to decrease blood volume and reduce fluid collection in the lungs and legs.
Diuretics can be divided into:
- loop diuretics
- thiazide diuretics
Most doctors use furosemide, a common potent loop diuretic, for patients with significant fluid retention.
In contrast, thiazides are not as strong, but they’re helpful for people with hypertension and heart failure because they lower your blood pressure.
Examples of thiazide diuretics include:
Side effects of diuretics include:
- low blood pressure
- rise in blood nitrogen concentration
- electrolyte problems
- elevated uric acid levels
People taking diuretics should regularly monitor their electrolytes and uric acid levels.
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Vasodilators are medications that make the blood vessels relax.
These drugs stimulate the release of nitric oxide, which relaxes the smooth muscles of arteries and veins. As a result, the blood vessel resistance drops, and the load on the heart declines.
The use of vasodilators may cause the following side effects:
- heart palpitations
- joint pain
- skin rash
Digoxin helps to increase the force and speed of contraction of the heart muscles.
This drug is helpful for people with left ventricular heart failure. Digoxin inhibits the sodium-potassium ATPase pump in the heart muscles and deactivates the sympathetic and RAAS responses in heart failure.
Digoxin can cause dose-related side effects, including:
- visual changes
- gastrointestinal effects such as nausea, vomiting, and abdominal pain
Other heart failure medications
Depending on your clinical status, a doctor may decide to place you on supportive medications. Examples of supportive medications for heart failure are:
- Anticoagulants: Blood thinners, such as warfarin, reduce the risk of blood clot formation in the veins.
- Statins: These medications reduce the blood level of cholesterol. Examples include atorvastatin (Lipitor) and simvastatin (Zocor).
Heart failure medication guidelines
The American Heart Association (AHA) summarises the most recent medication guidelines for heart failure as follows:
- ACE inhibitors and ARBs are suitable first-line treatments for heart failure.
- Four foundational medication classes — sodium-glucose cotransporter-2 inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and renin-angiotensin system inhibitors — are now included in guideline-directed medical therapy for heart failure.
- A healthcare team specializing in heart failure should manage people with advanced heart failure to improve their survival rate.
Heart failure medications work via different mechanisms to relieve the symptoms of heart failure.
Doctors usually prescribe ACE inhibitors, ARBs, beta-blockers, digoxin, and other supportive medications for this condition.
Heart failure treatment typically involves a combination of these medications. If you’re taking heart failure medication, a healthcare professional can answer any questions about your treatment.
- Hill RD, et al. (2022). Angiotensin II receptor blockers (ARB). https://www.ncbi.nlm.nih.gov/books/NBK537027/
- Hopper I, et al. (2017). Chronic heart failure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601966/
- Medications used to treat heart failure. (2017). https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure
- Shah A, et al. (2017). Heart failure: A class review of pharmacotherapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481297/
- Top things to know: 2022 guideline for the management of heart failure. (2022). https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-heart-failure/top-things-to-know