Heart Failure Medications: Available Options
Medically reviewed by Alex Yampolsky, PharmD
Close to 6.5 million Americans over the age of 20 have heart failure. Furthermore, there are as many as 960,000 new heart failure cases yearly.
Fortunately, if you are one of the millions of Americans who have or have previously had heart failure, your healthcare provider can prescribe various medications to manage your precise condition and associated symptoms quickly and effectively.
These prescription drugs may help control symptoms, prevent your condition from worsening, and help you live longer.
Common medications used in people with heart failure include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta-blockers.
This article will outline the types of drugs used for heart failure and provide important information about each type of drug.
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Understanding Heart Failure
Heart failure is a medical condition in which the heart cannot contract to efficiently pump enough blood throughout the body, causing symptoms like cough, fatigue, breathing problems, and swelling.
Heart failure is most commonly caused by coronary artery disease (CAD) or hypertension (high blood pressure) that is not well controlled. It can also be caused by cardiac arrhythmia (abnormal heart rhythm), or other medical conditions affecting body parts, such as health conditions regarding the lungs or thyroid.
If left unaddressed, long-term heart failure can lead to congestive heart failure (CHF), which occurs when the heart's pumping ability continues to become less effective, causing fluid build-up in the lungs, liver, stomach, intestines, arms, and legs.
Types of Heart Failure Medications
Commonly prescribed medications for heart failure include:
ACE inhibitors and ARBs: These medications work on different parts of the renin-angiotensin system (RAS), a system in the body that regulates blood pressure, fluid balance, and other functions. These medications widen the blood vessels, helping lower blood pressure, reduce the heart's workload, and keep heart failure from worsening.
Beta-blockers: This class of drugs works by slowing the heart rate and decreasing the strength of heart muscle contractions. Over time, they keep heart failure from worsening and may help strengthen the heart.
While this article will provide an in-depth focus on the drug classes listed above, there are other drug classes commonly prescribed for heart failure which we will also briefly discuss, including:
Angiotensin-receptor neprilysin inhibitors (ARNIs): A type of medication used for heart failure patients with reduced ejection fraction, meaning reduced function of the main pumping chamber)
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors (also called gliflozins): A class of drugs that lower your blood sugar levels by preventing your kidneys from reabsorbing sugar created by the body)
Diuretics (water pills), help your body get rid of extra fluid
ACE Inhibitors
ACE inhibitors treat heart disease, heart failure, high blood pressure, and kidney problems (they are also considered protective of the kidneys, especially in people with diabetes), and can lower the risk for stroke or heart attack.
As described above, ACE inhibitors work on the RAS. More specifically, ACE inhibitors, such as Lotensin (benazepril), inhibit an enzyme (angiotensin-converting enzyme) that helps convert angiotensin I to angiotensin II.
Angiotensin II causes high blood pressure and fluid retention. Therefore, ACE inhibitors help lower blood pressure and improve heart failure by inhibiting the production of angiotensin II.
ACE inhibitors are taken orally (by mouth). Notice that the active ingredients in ACE inhibitors always end in the letters "-pril."
Ask your healthcare provider which ACE inhibitor is best for you. Because everyone has a unique medical history, there are many factors to consider when picking a medication.
Vasotec (Enalapril)
Vasotec (enalapril) is an ACE inhibitor shown in clinical studies to reduce deaths by 16% and lower the risk of being hospitalized for heart failure.
Vasotec is Food and Drug Administration (FDA)–approved to treat heart failure and high blood pressure in adults (18 and older) and children.
Zestril (Lisinopril)
Studies show Zestril to be effective and well-tolerated, even at higher doses. Typically, it is taken alongside a diuretic, such as hydrochlorothiazide. Zestril works to improve heart failure-related symptoms.
At high doses, it helps keeps people with heart failure healthier and reduces the risk of death.
Zestril is FDA-approved to treat heart failure in adults and hypertension in adults and children 6 and older. It is also used after a heart attack to improve survival.
Lotensin (Benazepril)
Lotensin has been shown to effectively lower blood pressure in people with mild to moderate hypertension. However, people with severely high blood pressure may need multiple drugs to achieve blood pressure control.
Lotensin helps improve symptoms and exercise capacity in people with congestive heart failure.
Furthermore, studies have found benazepril, its active ingredient, a drug often combined with amlodipine, to be well-tolerated.
Lotensin is FDA-approved to treat heart failure and high blood pressure in adults and children 6 years and older.
Altace (Ramipril)
Altace is FDA-approved for adults to treat hypertension and heart failure (including after a heart attack).
It also lowers the risk of heart-related death, heart attack, and stroke in adults 55 and older at high risk of these heart-related events.
For high-risk individuals, studies have shown that Altace can reduce the mortality rate and the odds of heart attack, stroke, revascularization (surgery to open up blocked arteries or veins), cardiac arrest (an electrical disturbance that causes the heart to stop), complications related to diabetes, and new cases of diabetes.
Trandolapril
Studies show that long-term treatment with this generic medicine (no longer manufactured under a brand name) in individuals with reduced left ventricular function soon after a heart attack reduced the risk of overall death, heart-related death, sudden death, and severe heart failure.
Trandolapril is approved for adults to treat high blood pressure and heart failure, including after a heart attack.
Side Effects of ACE Inhibitors
Common side effects of ACE inhibitors include:
Dry cough (occurs in about 10% of people who take an ACE inhibitor)
Dizziness
Headache
Upset stomach and diarrhea
Numbness
Fever
Skin rashes or blisters
Joint pain
Swelling of the mouth, tongue, or throat (requires emergency medical attention)
Angiotensin Receptor Blockers
ARBs work on the RAS but at a different part than ACE inhibitors. While ACE inhibitors restrain the production of angiotensin II, ARBs work later in the cycle.
They prevent angiotensin II from binding to a receptor. Preventing this binding stops angiotensin II from producing its effects, such as narrowing blood vessels and increasing blood pressure.
If you take an ARB, you may take it along with other medications, but you will not take it along with an ACE inhibitor.
ARBs taken by mouth are generally prescribed to lower blood pressure, treat heart failure, and protect the kidneys.
The active ingredients in ARBs contain the suffix -sartan.
Cozaar (Losartan)
Cozaar was the first ARB to be approved by the FDA. Clinical studies showed losartan to be effective and well-tolerated.
Cozaar treats hypertension in adults and children 6 and older. It's also prescribed to prevent stroke in people with both high blood pressure and left ventricular hypertrophy (LVH; thickening of the walls of the heart's left ventricle).
Losartan, Cozaar's active ingredient, is also used to prevent kidney complications in people with diabetes.
Diovan (Valsartan)
Studies show that people taking Diovan have a lower risk of heart failure and diabetes.
Diovan, with the active ingredient valsartan, is FDA-approved to treat hypertension (high blood pressure) in adults and children, treat heart failure in adults, and lower the risk of heart-related death in people who have had a heart attack and also have left ventricular failure or left ventricular dysfunction.
Benicar (Olmesartan)
Benicar, with the active ingredient olmesartan, has been shown to have protective effects on the kidneys, preventing complications of diabetes.
Benicar is FDA-approved in adults and children to treat high blood pressure.
Avapro (Irbesartan)
Avapro, containing irbesartan, is considered effective in treating high blood pressure.
Avapro is used to treat high blood pressure in adults, as well as to treat kidney complications in people who have diabetes.
Edarbi (Azilsartan)
Azilsartan, which is only available under the brand name Edarbi, contains the active ingredient azilsartan. Studies show that it may have a slightly more significant effect on blood pressure than other ARBs.
Edarbi is FDA-approved to treat adults with high blood pressure.
A Word on Off-Label Prescribing
Off-label prescribing is when a medication is prescribed for a use not approved by the FDA. Healthcare providers will still prescribe it for certain conditions because studies have shown benefits for its use.
For example, although the ACE inhibitors listed above are not FDA-approved to protect the kidneys, studies have shown that all ACE inhibitors and ARBs have this effect.
Studies have also found that all ACE inhibitors and ARBs are equally effective.
Side Effects of ARBs
Common side effects of ARBs include:
Dizziness
Light-headedness
Headache
Fatigue
Dry cough (occurs in about 3% of people who take an ARB)
Swelling of the mouth, tongue, or throat (requires emergency medical attention)
Which ARB Is Right for Me?
Ask your healthcare provider which ARB is best for you. Because everyone has a unique medical history, your provider will consider many factors before prescribing a medication.
Only your healthcare provider can decide which medication is most appropriate for you.
Beta-Blockers
Beta-blocker medicines, used for blood pressure and other heart conditions, including heart failure, work on beta receptors in the body.
The three main types of beta receptors are:
Beta-1 receptors: Mostly found in the heart
Beta-2 receptors: Mostly found in vascular and bronchial smooth muscle
Beta-3 receptors: Mostly found in fat tissues
Cardioselective beta-blockers bind to beta-1 receptors, while non-cardioselective beta-blockers bind to beta-1 and beta-2 receptors.
Non-cardioselective beta-blockers tend to have more side effects since they affect other areas of the body than the heart. Notice that the active ingredients in beta-blockers end in "-lol."
Some examples of cardioselective beta-blockers include:
Bystolic (nebivolol)
Lopressor (metoprolol tartrate)
Tenormin (atenolol)
Toprol XL (metoprolol succinate extended-release)
Some examples of non-cardioselective beta-blockers include:
Inderal LA (propranolol)
Coreg (carvedilol)
Trandate (labetalol) are nonselective beta-blockers with alpha-blocking effects
Side Effects of Beta-Blockers
Common side effects of beta-blockers include:
Trouble falling or staying asleep
Nightmares
Tiredness
Dizziness
Slowed heartbeat
Sexual problems
Heart block (blocked electrical signals that control the heartbeat)
Increased blood sugar levels
Which Beta-Blocker Is Right for Me?
Ask your healthcare provider which beta-blocker is best for you. Because everyone has a unique medical history, there are many factors to consider when picking a medication.
Only your healthcare provider can decide which medication is most appropriate for you.
Other Medications Prescribed for Heart Failure
In addition to the medications described above, other medicines may be prescribed for people with heart failure, which may include:
ARNIs: Entresto (sacubitril/valsartan) is an ARNI that combines two drugs, a neprilysin inhibitor, and an ARB.
Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker: Corlanor (ivabradine) is the first drug in this class to treat heart failure and lower the risk of hospitalization for people with heart failure.
SGLT-2 inhibitors, such as Farxiga (dapagliflozin), Jardiance (empagliflozin), and Inpefa (sotagliflozin), are approved for the treatment of type 2 diabetes but are also approved to treat people at risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits.
Diuretics: Various types of diuretics help the body eliminate extra fluid. Examples include Lasix (furosemide) and Inspra (eplerenone). Many medications described above, such as ACE inhibitors or ARBs, are prescribed in combination with a diuretic, either as two separate drugs or as a combination medication.
Antiplatelet drugs (medications that prevent blood clots from forming), such as Plavix (clopidogrel)
Blood-thinning medications, such as Jantoven (warfarin)
Cholesterol-lowering medications, such as Lipitor (atorvastatin)
Antiarrhythmic medicines, such as Pacerone (amiodarone), for people with heart failure and abnormal heart rhythm
Calcium channel blockers (drugs that treat chest pain, irregular heartbeats, and high blood pressure), such as Verelan PM (verapamil)
Vasodilators (class of medication that dilate arteries and veins), such as Bidil (hydralazine)
Summary
There are various medications that your healthcare provider may prescribe for heart failure. All of these medications have different benefits as well as side effects.
Your healthcare provider will consider many factors, such as your medical condition, symptoms, family history, risk factors, and others, and determine which heart failure medication(s) will be most appropriate for you.
You can also ask your healthcare provider for recommendations on lifestyle changes such as diet and exercise, which you can try along with your medication.
Frequently Asked Questions
What heart failure medication has the fewest side effects?
It's hard to say which medication has the fewest side effects because people react differently to medicines.
What works great for someone may cause side effects in another person. Ask your healthcare provider for advice on the best medication.
How are heart failure medications generally stored?
Heart failure medications should generally be stored at room temperature (between 68 and 77 degrees F). Avoid direct light, heat, and moisture, and keep out of the reach and sight of children and pets.
Read the original article on Verywell Health.
