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Turning to Drugs for Heart Failure

While there have been setbacks in recent research, drugs remain the most common effective heart-failure treatment.
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Heart failure remains a serious and incurable disease, but heart-failure treatment with medications has been a tremendous success story. "I think that the drugs we've used have made an enormous impact on people with heart failure," says Marvin A. Konstam, MD, chief of cardiology and director of cardiovascular development at Tufts-New England Medical Center. "That's something we shouldn't lose sight of."

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Research into heart-failure treatment with drugs has suffered a few setbacks in recent years, as medications considered to have great potential did not prove as effective as hoped. Implantable devices like defibrillators, LVADs, and biventricular pacers are also generating a great deal of excitement as new ways to treat the condition.

But given the novelty and expense of implantable devices, it's likely that heart-failure treatment for most people will consist of drugs alone in the near future, according to Michael R. Bristow, MD, PhD, from the University of Colorado Health Sciences Center. The good news is that standard drugs for heart-failure treatment are effective and new ones are under development.

Standard Treatments

Heart-failure treatment with medication depends on a person's condition, whether you suffer from the more common systolic heart failure -- in which the heart has difficulty pumping -- or the rarer diastolic heart failure -- in which the heart is stiff and has trouble expanding to fill with blood.

Both conditions are helped by angiotensin-converting enzyme inhibitors (ACE inhibitors), which in the last decade have become the linchpin of heart-failure treatment. The success of ACE inhibitors in reducing sickness and death from heart failure demonstrated the significant role that hormones play in worsening heart failure and changed the focus of heart-failure treatment.

Some of the body's natural responses to a failing heart actually cause the condition to worsen. One is the body's release of hormones that constrict the blood vessels, making it harder for the weakened heart to pump blood. ACE inhibitors and other similar drugs block the effects of these hormones and widen the vessels, easing the heart's workload.

Beta-blockers are another prominent heart-failure treatment. In addition to lowering blood pressure and decreasing heart rate, these drugs also lessen the effects of the hormones that result from heart failure. Beta-blockers are tremendously useful drugs, resulting in almost a 50% reduction in the risk of death in people with heart failure.

Another common drug used in heart-failure treatment is diuretics, which help remove water and sodium from the blood. Still another drug, digoxin, is sometimes used to slow irregular heartbeats and increase the force of the heart's contractions. Depending on your condition, other medications may be necessary.

A possible substitute for people who cannot tolerate ACE inhibitors are angiotensin II receptor blockers (ARBs), which, like ACE inhibitors, affect the hormonal balance. Jay N. Cohn, MD, professor in the cardiovascular division at the University of Minnesota Medical School, led a major study of the ARB Diovan. He tells WebMD that he does not see ARBs as only a substitute for ACE inhibitors, but as a drug that can be used in combination with them when beta-blockers are not used. However, experts agree that ACE inhibitors, ARBs, and beta-blockers should not be taken together.

Some are less sure about the use of ARBs. "The ARBs should not, in my opinion, be routinely substituted for ACE Inhibitors," says Konstam. "Although they're linked by a common effect, they are different classes of drugs. While they look like they may be effective, for now they should be considered as second line treatment for heart failure."

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