New Delhi: Heart failure (HF) is a progressive illness where the heart is not able to circulate blood in adequate amounts to meet the needs of the body. This leads to fluid overload, tiredness, and shortness of breath. While modification of lifestyle and management of conditions is important, medications play a crucial role in the treatment of heart failure, to alleviate symptoms, improve cardiac function and reduce hospitalisation. There are many drug classes to treat heart failure targeting a distinct aspect of the disease. Some of the most prevalent drugs are listed below along with some necessary information patients need to know.
In an interaction with News9Live, Dr (Col) Sunil Sofat, Director, Interventional Cardiology & Electrophysiology/RF Ablation & Cardiac Pacing, Max Super Speciality Hospital, Noida, listed the most common drugs for treatment of heart failure.
- Angiotensin-Converting Enzyme (ACE) Inhibitors: ACE inhibitors relax blood vessels, making it easier for the heart to function and pump blood. They also lower blood pressure and limit fluid build-up, which is helpful for heart failure patients especially. ACE inhibitors can cause a chronic cough in some patients. They can raise blood potassium levels, so monitoring is required regularly. Patients with kidney disease history should exercise caution while taking ACE inhibitors.
- Angiotensin II Receptor Blockers (ARBs): ARBs work like ACE inhibitors, dilating blood vessels and improving blood flow. ARBs are usually given to patients who cannot tolerate ACE inhibitors due to side effects like coughing. ARBs can also lead to increased levels of potassium and affect the function of the kidneys. These drugs are normally administered once daily and must be taken regularly.
- ARNi (Angiotensin Receptor-Neprilysin Inhibitor): They are similar to ARBs and ACE inhibitors but are better than ACE inhibitors and ARBs in treating patients with heart failure in recent trials. These can also lead to increased levels of potassium and affect the function of the kidneys. They can cause chronic cough and should be started after stopping ace inhibitors for 48 hours.
- Beta-Blockers: Beta-blockers decrease the workload of the heart by decreasing the rate at which the heart beats and reducing blood pressure. This makes it easier for the heart to function. They have been proven to save the lives of heart failure patients. Beta-blockers may initially cause tiredness, dizziness, or a slower heart rate. It’s not advisable to abruptly discontinue beta-blockers, as this may exacerbate heart failure symptoms.
- Diuretics: Diuretics reduce fluid accumulation in the body by promoting increased urine production. This is vital for heart failure patients who develop swelling and shortness of breath because of fluid build-up. Diuretics can lead to dehydration and hypokalaemia, thus electrolyte monitoring is required. A balanced diet with adequate fluid intake should be maintained unless otherwise advised by a doctor.
- Aldosterone Antagonists: These medications inhibit the action of aldosterone, a hormone that contributes to fluid retention and elevated blood pressure. They are administered with other medications to avoid exacerbation of heart failure symptoms. Aldosterone antagonists cause potassium levels to increase.
- Hydralazine and Nitrates: This drug combination causes the blood vessels to widen and lowers the workload on the heart. It is sometimes used in people who cannot take ACE inhibitors or ARBs. The mix can cause dizziness, headaches, and low blood pressure.
- SGLT2 Inhibitors: Originally prescribed to treat diabetes, SGLT2 inhibitors have been beneficial to heart failure patients by improving heart function and reducing the risk of hospitalisation. The medications allow kidneys to flush out excess sugar and sodium, thereby lowering blood pressure and fluid accumulation. The drugs may cause frequent need to urinate and thirstiness. They also have a small risk of urinary tract infections (UTIs) and can lower blood sugar levels.
- HCN Channel Blockers (Ivabradine): They are used in patients with heart failure who have a high heart rate even after taking maximum doses of beta-blockers. They work by reducing the heart rate, thereby reducing the workload on the heart. They can cause visual impairment, for example, seeing flashes of light. It should be used only in patients who have a resting heart rate of over 70 beats per minute.
Conclusion
Heart failure is a complex condition, but by proper combination of medicines, the symptoms can be managed and the quality of life can be improved. Patients need to be closely managed by their healthcare providers to ensure that they know the reason for each drug, possible side effects, and the need to stick to the prescribed regimen. Regular follow-ups and monitoring are essential to adjust the treatment plan as needed. Patient should avoid self-medication and ensure timely visits with their treating doctor as advised.
Heart Failure Awareness Week: Heart failure can be prevented, but in case of treatment, 9 drugs can be helpful, diuretics for instance. Medicine Health News: Latest News from Health Care, Mental Health, Weight Loss, Disease, Nutrition, Healthcare
