More ways to manage medications for heart failure
Advocate for the best heart failure regimen.
The treatment regimen for heart failure varies, depending on the cause, the stage, and other factors. But experts agree that all heart failure patients should get the following drugs, unless there's some reason they can't take them:
An ACE inhibitor. These block the function of angiotensin-converting enzymes (ACE), relaxing blood vessel walls. They provide some immediate effect in lowering blood pressure, but their most important function is to "reverse remodel" the heart, which means reshape it closer to its normal size and form. ACE inhibitors also decrease the risk of death; studies show a reduction in mortality of 20 to 25 percent.
An angiotensin II receptor blocker (ARB). These dilate blood vessels and lower blood pressure, providing some symptom relief, but their primary benefits are long-term. ARBs have been shown to work over time to decrease mortality and "reverse remodel" the heart. ARBs may be used as an alternative to an ACE inhibitor or, in some cases, in addition to an ACE inhibitor.
A beta-blocker. These drugs slow and steady the heart rate and lower blood pressure. They improve the heart output (measured by ejection fracture) over time. There are two types of beta-blockers, known as selective and nonselective, depending on which type of beta receptors they work on. Beta-blockers have been shown to reduce the death rate from heart failure by as much as 30 percent.
Other treatment options:
Diuretics. Also sometimes called "water pills," diuretics increase urination and help the kidneys flush salt and water from the blood. Diuretics prevent the fluid retention typical of heart failure. They're extremely important in relieving the fluid "congestion" that gave congestive heart failure its original name.
Aldosterone inhibitors. These drugs block the action of a hormone that causes the body to retain, or hold on to, sodium and water. They're powerful diuretics and have the short-term benefits of preventing fluid buildup.
Other vasoactive agents. In addition to an ACE inhibitor and an angiotensin II receptor blocker, the doctor may prescribe a calcium channel blocker or nitroglycerin to relax and widen blood vessels and prevent constriction of blood flow. Among African-Americans, a combination of hydralazine and a long-acting nitrate was shown in the African American Heart Failure Trial to be most effective (along with an ACE inhibitor and beta-blocker) for moderate to severe heart failure.
Digoxin. This drug makes the heart pump more strongly and also may help control certain types of arrhythmias. Digoxin has been shown to control symptoms and reduce hospitalizations in the short term, but it doesn't have a long-term effect on heart muscle strength or life expectancy. It shouldn't be prescribed for those with preserved systolic failure unless it's being prescribed for atrial fibrillation.
In addition to a regimen specifically to treat heart failure, the doctor may prescribe other heart medications, such as nitrates for chest pain, a statin to lower cholesterol, or blood-thinners to prevent blood clots.