Medicines for Heart Failure

Topic Overview

How do medicines relieve my symptoms?

Medicines for heart failure help relieve the symptoms of heart failure by:

  • Removing excess fluid from the body. The class of medicines known as diuretics acts principally to rid the body of excess fluid.
  • Improving the ability of the heart to pump more effectively. Another type of medicine, digoxin, works primarily by increasing the strength of the contraction of the heart.
  • Preventing further injury to the heart. A class of medicines known as angiotensin-converting enzyme (ACE) inhibitors acts both by improving the efficiency of pumping and by preventing further damage to the heart.

How do medicines prolong my survival?

Several classes of medicines have been proven to increase the life span of people with heart failure. These include:

  • ACE inhibitors.
  • ARBs (angiotensin II receptor blockers).
  • Beta-blockers.
  • Spironolactone, a diuretic. (Other diuretics can improve symptoms but do not improve survival.)

The exact mechanism by which these medicines prolong survival is not entirely clear. Each medicine might have several beneficial effects for people with heart failure. In terms of prolonging survival, the most important effects may be the ability of these drugs to prevent both lethal abnormal heart rhythms and their ability to limit ongoing damage to the heart.

What types of medicines are used to treat heart failure?

There are many medicines that are designed to control symptoms of heart failure, improve heart function, and enhance chances of long-term survival. These medicines can be grouped together into classes of drugs that work in similar ways to treat heart failure. The three classes of medicines that have been proved to have the greatest benefit for people with heart failure are summarized in the following table.

Medicines for heart failure

Drug class

How it works

Examples

Diuretics

Diuretics stimulate your kidneys to get rid of extra fluid from your body. Since many of the symptoms of heart failure are caused by increased fluid in the body, diuretics can provide relief from some of the most uncomfortable symptoms.

Spironolactone also blocks the activity of a hormone called aldosterone that may contribute to worsening heart function.

  • Loop diuretics (Lasix)
  • Thiazide diuretics (hydrochlorothiazide and metolazone)
  • An aldosterone antagonist diuretic (spironolactone)
      
ACE inhibitors

Angiotensin-converting enzyme inhibitors block the production of angiotensin II, a hormone that makes heart failure worse by leading to salt and water retention, which increases blood pressure.

  • Captopril
  • Lisinopril
  • Enalapril

ARBs

Angiotensin II receptor blockers make it hard for the hormone angiotensin to work. This hormone causes blood vessels to narrow. ARBs help the blood vessels relax and widen, which reduces blood pressure. ARBs also increase the release of water and sodium to the urine, which lowers blood pressure too.

  • Candesartan
  • Losartan
  • Valsartan
Beta-blockers

Beta-blockers decrease the strength with which your heart contracts and beats. In the long term, beta-blockers appear to help prevent changes in the heart that make heart function worse.

  • Metoprolol
  • Carvedilol
  • Bisoprolol
         

Because there is very good evidence that ACE inhibitors, ARBs, beta-blockers, and spironolactone can prolong survival in people with heart failure, your doctor will aim to have you take these medicines, if appropriate.

Also, several other classes of medicines can be helpful in relieving symptoms of people with heart failure. There is less clear evidence that these medicines prolong survival, so your doctor will usually use these second-line medicines only if you are already taking each of the main classes of medicines or if you cannot tolerate one or more of the main medicines.

Second-line medicines for heart failure

Drug class

How it works

Examples

Vasodilators These drugs relax the smooth muscle in your arteries and therefore lower the amount of blood pressure the heart has to beat against. Nitrates also dilate the veins, alleviating some of the congestion from blood backed up behind the heart.
  • Hydralazine
  • Organic nitrates
  • Alpha-blockers
Calcium channel blockers These drugs are vasodilators. They may be particularly useful in diastolic heart failure. But they may make systolic heart failure worse. They slow the heart rate and decrease the force of the contraction of the heart, which may prevent further damage to the heart.
  • Verapamil
  • Diltiazem
Digoxin Digoxin increases the force of contraction of the heart.
  • Digoxin
Warfarin (Coumadin) Warfarin thins blood and prevents blood clots.
  • Warfarin

Nesiritide (Natrecor) is a man-made form of a natriuretic peptide, a naturally occurring hormone secreted by heart muscle. It helps relax certain blood vessels and gets rid of extra sodium and water from the body. This medicine is only used in a small number of people who are in the hospital with severe heart failure. Nesiritide is only used after trying other treatments. It can cause serious kidney problems, irregular heartbeats (arrhythmias), and low blood pressure. Nesiritide may increase the risk of death in people with heart failure.1

Related Information

References

Citations

  1. Sackner-Bernstein JD, et al. (2005). Short-term risk of death after treatment with nesiritide for decompensated heart failure: A pooled analysis of randomized controlled trials. JAMA, 293(15): 1900–1905.

Credits

Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Editor Marianne Flagg
Associate Editor Terrina Vail
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Last Updated August 25, 2008

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