Medication

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

• ACE inhibitors such as captopril and enalapril -- these medications open up blood vessels and decrease the work load of the heart. These are vital in treating heart failure
• Diuretics -- there are several types including thiazide, loop diuretics, and potassium-sparing diuretics; they help rid your body of fluid and sodium.
• Digitalis glycosides -- increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances
• Angiotensin receptor blockers (ARBs) such as losartan and candesartan which, like ACE inhibitors, reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors
• Beta-blockers -- this is particularly useful for those with a history of coronary artery disease

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.

• Benazepril (Lotrel) - (Stage A)
• Captopril (Capoten) - (Stages A, B, C)
• Enalapril (Vasotec) - (Stages A, B, C)
• Fosinopril (Monopril) - (Stages A, C)
• Lisinopril (Prinivil, Zestril) - (Stages A, B, C)
• Moexipril (Univasc) - (Stage A)
• Perindopril (Aceon) - (Stage A)
• Quinapril (Accupril) - (Stages A, C)
• Ramipril (Altace) - (Stages A, B, C)
• Trandolapril (Mavik) - (Stages A, B, C)

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. Although all ACE inhibitors can have this side effect, sometimes switching to another brand will reduce this symptom.
• Although ACE inhibitors can protect against kidney disease, they also increase potassium retention in the kidneys. This increases the risk for cardiac arrest if potassium levels become too high. Because of this action, they are not generally given with potassium-sparing diuretics or potassium supplements.
• A rare but severe side effect is granulocytopenia, which is an extreme reduction in infection-fighting white blood cells.
• In very rare cases, patients suffer a sudden and severe allergic reaction called angioedema that causes swelling in the eyes and mouth and may close off the throat.

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.

• Candesartan (Atacand) - (Stages A, C)
• Eprosartan (Teveten) - (Stage A)
• Irbesartan (Avapro) - (Stage A)
• Losartan (Cozaar) - (Stages A, B)
• Olmesartan (Benicar) - (Stage A)
• Telmisartan (Micardis) - (Stage A)
• Valsartan (Diovan) - (Stages A, B, C)

Common Side Effects

• Low blood pressure
• Dizziness and lightheadedness
• Raised potassium levels
• Drowsiness

Beta Blockers

Beta blockers are almost always used in combination with other drugs such as ACE inhibitors and diuretics. They help slow heart rate and lower blood pressure.

• Acebutolol (Sectral) - (Stage A)
• Atenolol (Tenormin) - (Stages A, B)
• Betaxolol (Kerlone) - (Stage A)
• Bisoprolol (Zebeta) - (Stages A, C)
• Cartelol (Cartrol) - (Stage A)
• Carvedilol (Coreg) - (Stages A, B, C)
• Labetalol (Trandate) - (Stage A)
• Metoprolol succinate (Toprol XL) - (Stages A, C)
• Metoprolol tartrate (Lopressor) - (Stages A, B)
• Nadolol (Corgard) - (Stage A)
• Penbutolol (Levatol) - (Stage A)
• Pindolol (Visken) - (Stage A)
• Propranolol (Inderal) - (Stages A, B)
• Timolol (Blocadren, Timolide) - (Stages A, B)

Common Side Effects

• Fatigue and lethargy
• Vivid dreams and nightmares
• Depression
• Memory loss
• Dizziness and lightheadedness
• Reduced ability to exercise
• Coldness in extremities (legs, toes, arms, hands)

Diuretics

Diuretics cause the kidneys to rid the body of excess salt and water. Fluid retention is a major symptom of heart failure. Aggressive use of diuretics can help eliminate excess body fluids, while reducing hospitalizations and improving exercise capacity:

• Potassium-sparing diuretics . These include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium).
• Thiazide diuretics . These include chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide (Lozol), hydrochlorothiazide (Esidrix, HydroDiuril), and metolazone (Mykrox, Zaroxolyn).
• Loop diuretics . Because loop diuretics act faster than other diuretics it is important to avoid dehydration and potassium loss. Loop diuretics include bumentanide (Bumex), furosemide (Lasix), and torsemide (Demadex).

Common Side Effects

• Fatigue
• Depression and irritability
• Urinary incontinence
• Reduced sexual drive

Aldosterone Blockers

Aldosterone is a hormone that is critical in controlling the body's balance of salt and water. Excessive levels may play important roles in hypertension and heart failure. Drugs that block aldosterone are prescribed for some patients with Stage C heart failure.

Digitalis

Digitalis may be useful for patients with left-side (systolic) dysfunction who do not respond to other drugs (diuretics, ACE inhibitors). It is also used for patients who have atrial fibrillation.

Digitalis may be harmful in patients with right-side heart failure and those who stop taking digoxin after using it in combination with ACE inhibitors.

Side Effects and Problems. While digitalis is generally a safe drug, it can have toxic side effects due to overdose or other accompanying conditions. The most serious side effects are arrhythmias (abnormal heart rhythms that can be life-threatening). Early signs of toxicity may be irregular heartbeat, nausea and vomiting, stomach pain, fatigue, visual disturbances (such as yellow vision, seeing halos around lights, flickering or flashing of lights), and emotional and mental disturbances.

Statins

Statins are important drugs used to lower cholesterol and to prevent heart disease leading to heart failure, even in people with normal cholesterol levels. The statins include lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor).

Nesiritide (Natrecor) .

Nesiritide treats patients who have decompensated heart failure. Decompensated heart failure is a life-threatening condition in which the heart fails over the course of minutes or a few days, often as the result of a heart attack or sudden and severe heart valve problems. However, nesiritide may cause serious kidney damage.

Aspirin

Aspirin is a type of non-steroid anti-inflammatory (NSAID). Aspirin is important for preventing heart failure death in patients with heart disease, and can safely be used with ACE inhibitors.