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Heart Failure Health Center

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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Standard Treatments continued...

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."

Aldosterone Blockers

Some of the most significant breakthroughs in drugs for heart-failure treatment have come from the aldosterone blockers, such as Aldactone (spironolactone), and more recently, Inspra. Like ACE inhibitors, these drugs work by affecting the hormones in the bloodstream, in this case, aldosterone, which can cause the retention of salt and water and other ill effects.

While Aldactone can have some unpleasant side effects -- such as impotence and gynecomastia (breast swelling in men) -- Inspra does not cause them. Both drugs can cause an increase in potassium levels, so patients need to be monitored. One significant difference between the drugs is price: Aldactone, having been around for decades as a high blood-pressure drug, is significantly cheaper than Inspra, which was approved in September 2002.

Bertram Pitt, MD, who has led major studies of both of these drugs for heart-failure treatment believes Aldactone may still be the best drug for those who aren't concerned about side effects. But for some, side effects are an important issue.

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