Medically Reviewed by Brunilda Nazario, MD on March 16, 2022
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Angiotensin-Receptor Neprilysin Inhibitor (ARNI)

This medication combines two drugs -- sacubitril and valsartan -- to flush out extra fluid in your body and relax blood vessels. You might need it if your heart’s main pumping chamber isn’t working at full power. Over time, it’s been shown to improve ejection fraction. That measures your heart’s pumping ability. Entresto is the only ARNI available for heart failure.

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Angiotensin-Converting Enzyme (ACE) Inhibitors

These drugs block the effects of angiotensin II, a hormone your kidneys make. This allows blood vessels to relax, which lowers blood pressure. It also helps your blood flow better and eases heart strain. Your doctor might prescribe:

  • Captopril (Capoten)
  • Enalapril (Epaned, Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Qbrelis, Zestril)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)
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Angiotensin II Receptor Blockers (ARBs)

Also known as angiotensin-2 receptor antagonists, these work similarly to ACE inhibitors. They might be a good choice if you can’t tolerate  ACE inhibitors because of cough or angioedema. Options include:

  • Candesartan (Atacand)
  • Losartan (Cozaar)
  • Valsartan (Diovan)
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Beta-Blockers

When your heart isn’t working properly, it triggers the release of the hormones adrenaline and noradrenaline. These make your heart beat faster and raise blood pressure. Beta-blockers lower both your heart rate and blood pressure. Options include:

  • Bisoprolol (Zebeta)
  • Carvedilol (Coreg)
  • Carvedilol CR (Coreg CR, Toprol XL)
  • Metoprolol succinate (Toprol XL, Lopressor, Kapspargo Sprinkle)
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If Channel Blocker or Inhibitor

Like beta-blockers, this drug slows your heart rate. Your doctor may prescribe ivabradine (Corlanor).

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Diuretics

Also called water pills, these help flush out extra fluid and sodium from your body through your urine. This takes strain off your heart. Options include:

  • Amiloride (Midamor)
  • Bumetanide (Bumex)
  • Chlorothiazide (Diuril)
  • Furosemide (Lasix)
  • Hydrochlorothiazide or HCTZ (Esidrix, Hydrodiuril)
  • Indapamide (Lozol)
  • Metolazone (Zaroxolyn)
  • Torsemide (Demadex)
  • Triamterene (Dyrenium)
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Aldosterone Receptor Antagonists

They block the effects of hormones at work in your kidneys, so they make more urine to flush out extra fluid and salt. Aldosterone antagonists help with serious systolic heart failure. They also boost potassium levels, so your doctor may suggest cutting back on foods high in potassium. Medications include eplerenone (Inspra) and spironolactone (Aldactone, Carospir).

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Hydralazine and Isosorbide Dinitrate (BiDil)

If ACE inhibitors or beta-blockers don’t ease your symptoms, your doctor might also prescribe this combination drug, which works to relax blood vessels. Research suggests this medication specifically benefits Black people. The combination has been shown to lower the rate of first hospitalizations for heart failure and improve survival in this population.

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Oral Soluble Guanylate Cyclase (sGC)

This is a more recently released medicine for chronic heart failure you take once a day. Studies show people with high-risk heart failure visited the hospital less often for heart failure than those who took a placebo. it’s sold under the name vericiguat (Verquvo).

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Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors

These drug were recently approved for heart failure. Originally intended for people with poorly controlled type 2 diabetes, it stops your kidneys from absorbing glucose. Instead, the glucose is flushed out when you pee. This takes strain off your heart. Options include canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).

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Other Medicines

Other drugs for heart failure include nitrates for chest pain, statins to lower cholesterol, or blood thinners to avoid blood clots. Your doctor could also prescribe digoxin (Lanoxin) to help with heart muscle contractions. It’s typically used in people with a heart rhythm problem.

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Surgery

It’s possible your doctor will say you need surgery to correct the root cause of your heart failure. These include coronary bypass to unblock arteries and heart valve surgery to repair or replace a damaged valve. You may need an implantable cardioverter-defibrillator to prevent more heart failure problems, or cardiac resynchronization therapy to treat heart chambers pumping out of sync. A ventricular assist device can help pump blood from your lower heart chambers to your entire body. A heart transplant may be needed in severe cases.

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Lifestyle Changes

Doing things differently can make for a healthier heart, too.If you smoke, quit.It damages blood vessels over time. You’re also more likely to have higher blood pressure and a faster heart rate, along with lower blood oxygen.Try to eat healthy foods.Avoid too much salt and add more fruits, veggies, and whole grains. Opt for lean protein and fat-free or low-fat dairy.Do your best to manage stress.It raises your heart rate and blood pressure, which can worsen heart failure symptoms.

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SOURCES:

Mayo Clinic: “Heart failure.”

American Heart Association: “Medications Used to Treat Heart Failure.”

Heartfailurematters.org: “Angiotensin Receptor-Neprilysin Inhibitor (ARNI) - Sacubitril/Valsartan.”

Heart Foundation: “Angiotensin receptor neprilysin inhibitors (ARNIs).”

FDA: “FDA approves new treatment for a type of heart failure.”

The Johns Hopkins Patient Guide to Diabetes: “SGLT2 INHIBITORS.”