“Heart failure” means the heart cannot adequately pump enough blood throughout the body. Heart failure medications can help reduce stress on the heart and manage symptoms, such as water retention, so a person can feel better.
According to the
Heart failure is more common in people with certain health conditions, such as diabetes. A person may need to take medication for other conditions as well as medications for heart failure.
This article explains which medications manage heart failure and how they work. It also details ways to prevent heart failure and heart disease overall.
Some medications a doctor may prescribe for heart failure
- Renin-angiotensin system inhibitors: This class of medications
- angiotensin II receptor blockers (ARBs), such as valsartan
- angiotensin converting enzyme (ACE) inhibitors, such as ramipril
- angiotensin receptor neprilysin inhibitors (ARNI), a new class of drugs that combines an ARB and a neprilysin inhibitor
- Beta-blockers: Beta-blockers block one or more beta receptors. This can change heart rhythm, modify blood pressure, and treat symptoms of some other illnesses. Beta-blocker drugs include:
- Mineralocorticoid receptor antagonists: Mineralocorticoid receptor antagonists, such as spironolactone and eplerenone, can treat heart failure in people with a very low ejection fraction and heart failure symptoms following a heart attack.
- Diuretics: Diuretics help the body get rid of excess fluid. This can reduce pain and swelling. Some diuretics include:
A doctor may also prescribe other medications:
- Hydralazine and isosorbide dinitrate are
specifically designedfor African Americans with heart failure.
- Statins can lower cholesterol.
- Sodium-glucose cotransporter-2 (SGLT2) inhibitors
lowerblood glucose, which may helpreduce the risk of heart failure compilations.
- Blood thinners may help reduce the risk of a heart attack or pulmonary embolism, especially in people with atrial fibrillation.
ACE inhibitors are part of a group of drugs called renin-angiotensin system inhibitors. They reduce the expression of angiotensin converting enzyme, a hormone that helps control blood pressure. ACE inhibitors relax blood vessels, reducing how hard and fast the heart has to beat.
Short- and long-acting ACE inhibitors exist. The longer-acting forms require a single daily dose. Short-acting forms require three doses each day.
Some people experience a dry, chronic cough as a side effect. Rarely, a person may experience decreased kidney blood flow, a condition doctors call renal stenosis.
ACE inhibitors include:
- captopril (Capoten)
- enalapril (Vasotec)
- fosinopril (Monopril)
- lisinopril (Zestril)
- perindopril (Coversyl)
- quinapril (Accupril).
- ramipril (Altace)
- trandolapril (Mavik)
In April 2022, the drugmaker Pfizer issued a
High levels of nitrosamine have the potential to cause cancer. It was found to exist in the drug at levels greater than the Acceptable Daily Intake (ADI) as determined by the Food and Drug Administration (FDA).
This recall is specific to only a handful of lot numbers and does not affect all Accupril tablets made by Pfizer.
If you take Accupril tablets, talk with your pharmacist or doctor. They will help you determine whether the recall has impacted your medication.
African Americans taking ACE inhibitors have a higher rate of edema when taking the medication.
Like ACE inhibitors, ARBs are renin-angiotensin system inhibitors. A doctor
They work by targeting angiotensin II, a chemical that constricts blood vessels. This helps blood vessels relax so the heart does not work as hard. This, in turn, lowers blood pressure and heart rate.
ARBs can cause a cough, but less frequently than ACE inhibitors do. They may also cause low blood pressure, so they are not safe for people with heart failure and very low blood pressure. ARBs can worsen symptoms of bilateral renal stenosis.
Epinephrine also plays a role in many other functions, so a person can have a wide range of side effects, including:
In males, MRAs may cause breast development and loss of libido. They can also cause too much potassium in the blood. Doctors do not recommend MRAs for people with kidney failure.
Females may experience menstrual disruptions when taking MRAs.
Some people also experience:
Diuretics lower the amount of water and salt in the body. This allows the heart to work less hard, lowering blood pressure. They can also reduce water retention and swelling.
Common side effects of ivabradine are:
- atrial fibrillation
- high blood pressure
- low blood pressure
Some people may also develop vision side effects.
Ivabradine is not safe for people with:
- decompensated heart failure
- very low blood pressure
- very low resting heart rate
- severe liver failure
Sacubitril/valsartan is the first in a new class of angiotensin receptor neprilysin inhibitor (ARNI) drugs. It slows the breakdown of neprilysin, helping expand the blood vessels and reducing blood pressure and heart rate.
It also includes an ARB, another drug that relaxes blood vessels.
Sacubitril/valsartan can cause:
- low blood pressure
- excess blood potassium
- swelling under the skin
- kidney failure, in rare cases
Hydralazine with nitrate
Hydralazine and nitrate can improve survival in people with heart failure and reduce ejection fraction. Doctors primarily use it to treat heart failure in African Americans, often with other medications.
Like many other heart drugs, it relaxes blood vessels and the heart, helping the heart work less hard and lowering blood pressure. It can cause nausea, vomiting, and dizziness, especially when changing position. Side effects may get worse if a person does not drink enough fluids.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors
Some people can experience:
- yeast infections
- kidney dysfunction
- increased cholesterol
- increased acid levels in the blood
- increased risk of urinary tract infections (UTIs)
In addition to heart medications,
Another drug doctors may prescribe for heart failure is digoxin.
Digoxin (Lanoxin) is a drug that:
- increases the force and speed of heart contractions
- slows heart rate
- slows activity in the atrioventricular node, which allows the ventricles to fill
- reduces activity in the sympathetic nervous system (which is responsible for the fight-or-flight response) and the renin-angiotensin system
Heart failure can be life threatening. It can also cause chronic health symptoms.
The outlook varies from person to person. It depends on many factors, including access to treatment, overall health, and lifestyle.
- 1 year: 80.8%
- 5 years: 48.2%
- 10 years: 26.2%
Lifestyle changes that may help
- maintaining a moderate weight
- tracking daily fluid intake
- quitting smoking
- avoiding or limiting alcohol
- avoiding or limiting caffeine
- eating heart-healthy foods
- being active, including sexually active
- managing stress
- monitoring blood pressure
- getting vaccinated against the flu and pneumonia
- choosing loose-fitting socks and dressing in layers
Maintaining a moderate weight is also important because it can help a person detect changes in their condition more easily. People who gain 3 or more pounds in a day or 5 or more pounds in a week may have worsening heart failure.
Additionally, eating a heart-healthy diet may help slow heart failure progression. People may wish to avoid or limit their consumption of:
- saturated fats
- trans fats
- red meat
A person can still be physically active and have sex if they have heart failure. However, certain adjustments are necessary to reduce stress and strain on the heart. Doctors can help provide people with appropriate guidelines.
While some lifestyle changes are easier to implement than others, adopting appropriate habits can drastically improve a person’s quality of life when living with heart failure.
Heart failure can cause symptoms that make daily life more difficult, but it is treatable with medications.
Heart failure medications reduce the strain on the heart, which can relieve symptoms, improve quality of life, and potentially help a person live longer.
There is no single combination of medications that works for everyone. People with heart failure can discuss treatment options, side effects, and treatment goals with a cardiologist.
People who experience unpleasant side effects or worsening symptoms should tell their doctor immediately. In many cases, a different medication may help.