Medications

Many different medications are used in the treatment of heart failure. They include:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin-receptor blockers (ARBs)
• Beta blockers
• Diuretics
• Aldosterone blockers
• Digitalis
• Hydralazine and nitrates
• Statins
• Aspirin and warfarin

ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are among the most important drugs for treating patients with heart failure. ACE inhibitors open blood vessels and decrease the workload of the heart. They are used to treat high blood pressure but can also help improve heart and lung muscle function. ACE inhibitors are particularly important for patients with diabetes, because they also help slow progression of kidney disease.

Brands and Indications. ACE inhibitors are used to treat Stage A high-risk conditions such as high blood pressure, heart disease, and diabetic nerve disorders (neuropathy). They are also used to treat Stage B patients who have had a heart attack or who have left ventricular systolic disorder, and Stage C patients with heart failure. Specific brands of ACE inhibitors include:

• Benazepril (Lotensin, generic)
• Captopril (Capoten, generic)
• Enalapril (Vasotec, generic)
• Fosinopril (Monopril, generic)
• Lisinopril (Prinivil, Zestril, generic)
• Moexipril (Univasc, generic)
• Perindopril (Aceon, generic)
• Quinapril (Accupril, generic)
• Ramipril (Altace, generic)
• Trandolapril (Mavik, generic)

Side Effects of ACE Inhibitors:

• Low blood pressure is the main side effect of ACE inhibitors. This can be severe in some patients, especially at the start of therapy.
• Irritating cough is a common side effect, which some people find intolerable. All ACE inhibitors can have this side effect, but angiotensin-receptor blockers do not.
• Although ACE inhibitors can protect against kidney disease, they also increase potassium retention by the kidneys. This increases the risk for cardiac arrest (when the heart stops beating) if potassium levels become too high. Because of this action, they are not generally given with potassium-sparing diuretics or potassium supplements.
• Patients who have difficulty tolerating ACE inhibitor side effects are usually switched to an angiotensin-receptor blocker (ARB).

Angiotensin-Receptor Blockers (ARBs)

ARBs, also known as angiotensin II receptor antagonists, are similar to ACE inhibitors in their ability to open blood vessels and lower blood pressure. They may have fewer or less-severe side effects than ACE inhibitors, especially coughing, and are sometimes prescribed as an alternative to ACE inhibitors. Some patients with heart failure take an ACE inhibitor along with an ARB.

Brands and Indications. ARBs are used to treat Stage A high-risk conditions such as high blood pressure and diabetic nerve disorders (neuropathy). They are also used to treat Stage B patients who have had a heart attack or who have left ventricular systolic disorder, and Stage C patients with heart failure. Specific brands include:

• < Page
1 2 3 4 5
• >

Review Date: 05/04/2011
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)