Treatment for Congestive Heart Failure

You and your doctor have many options for managing heart failure. In the early stages, lifestyle measures and medications are usually all that are needed to keep symptoms under control. But as the disease becomes more severe, you may need more advanced treatments, such as an implantable device, to improve heart function.

Lifestyle measures. The first steps in the treatment of heart failure may include limits on the amount of fluids consumed (including alcohol) and reductions in dietary sodium (less than 2,000 mg per day). In addition, follow your doctor's instructions on getting regular exercise, which can help prevent symptoms from worsening.

Medications. A variety of drugs may be used to manage heart failure. The medications your physician prescribes will depend on your specific condition, including the severity of your heart failure, its cause, and the presence of other health problems. Here's a look at the key drugs for heart failure patients:

  • ACE inhibitors and ARBs. ACE inhibitors—such as enalapril (Vasotec) and lisinopril (Prinivil, Zestril)—are the cornerstone of drug treatment for people with heart failure. ACE inhibitors promote dilation of the blood vessels and thus improve blood flow and slow the progression of CHD. They can also reduce blood pressure and lighten the workload on the heart. If you develop a bothersome dry cough while taking an ACE inhibitor, your doctor may instead prescribe an ARB, such as candesartan (Atacand) or valsartan (Diovan).
  • Diuretics and digoxin. Your physician may prescribe diuretics to reduce fluid buildup and digoxin (Lanoxin) to strengthen the heartbeat. Thiazide diuretics are effective for mild heart failure, but more potent drugs such as the loop diuretic furosemide (Lasix) are used for severe fluid retention. People whose heart failure does not respond to a single diuretic may require a combination of several types of diuretic drugs, each with a different mechanism of action.
  • Beta-blockers. These drugs—such as carvedilol (Coreg) and metoprolol (Toprol XL)—also can decrease the workload of the heart. In an analysis of data from 17 studies, researchers concluded that the risk of death from all causes was 31 percent lower in patients with heart failure who were treated with beta-blockers than in those not receiving such medications. In three other large trials, carvedilol reduced deaths and total hospitalizations by up to 50 percent when added to standard treatment for heart failure.
  • Aldosterone blockers. Spironolactone (Aldactone) and eplerenone (Inspra) block the activity of aldosterone, an adrenal hormone that causes sodium retention. Aldosterone blockers are prescribed to individuals who develop heart failure after a heart attack, and studies show that these drugs can reduce the risk of hospitalization and death from cardiovascular disease.
  • BiDil (isosorbide dinitrate/hydralazine). This drug combination is recommended for use in black people who still experience symptoms of heart failure while taking an ACE inhibitor and a beta-blocker. BiDil works by enhancing the availability of nitric oxide, which causes blood vessels to dilate. Research shows that BiDil helps improve survival in African Americans, but whether it is beneficial for Caucasians or other ethnic groups is still unknown.

Publication Review By: Gary Gerstenblith, M.D.; Simeon Margolis, M.D., Ph.D.

Published: 01 Jul 2013

Last Modified: 01 Jul 2013