What are the medications and brand names of Guideline-Directed Medical Therapy (GDMT) for Heart Failure (HF)?

From the Guidelines

Guideline-directed medical therapy (GDMT) for heart failure includes several medication classes that have been proven to reduce mortality and hospitalizations, and the most recent guidelines recommend the use of ACE inhibitors, ARBs, ARNIs, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and diuretics. The medications and brand names for GDMT include:

• ACE inhibitors: lisinopril (Prinivil, Zestril), enalapril (Vasotec), ramipril (Altace), and captopril (Capoten) 1
• ARBs: losartan (Cozaar), valsartan (Diovan), and candesartan (Atacand) 1
• ARNIs: sacubitril/valsartan (Entresto) 1
• Beta-blockers: carvedilol (Coreg), metoprolol succinate (Toprol XL), and bisoprolol (Zebeta) 1
• Mineralocorticoid receptor antagonists: spironolactone (Aldactone) and eplerenone (Inspra) 1
• SGLT2 inhibitors: dapagliflozin (Farxiga) and empagliflozin (Jardiance) 1
• Diuretics: furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex) 1 These medications work through different mechanisms, including reducing cardiac workload, preventing adverse remodeling, and improving neurohormonal balance, which collectively improve cardiac function and patient outcomes.

The most recent guidelines, published in 2022, recommend the use of these medication classes for patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) 1. The guidelines also recommend the use of hydralazine and isosorbide dinitrate (BiDil) combination therapy in African American patients with HFrEF.

It is essential to note that the choice of medication and dosage should be individualized based on the patient's specific needs and medical history. The guidelines recommend that GDMT should be initiated and titrated to maximally tolerated doses to achieve the maximal benefits in patients with chronic HFrEF 1.

The key to managing heart failure is to use a combination of these medications to reduce morbidity and mortality, and to improve the patient's quality of life. The use of GDMT has been shown to improve outcomes in patients with heart failure, and it is essential to follow the most recent guidelines to ensure that patients receive the best possible care.

From the FDA Drug Label

14 CLINICAL STUDIES

Dosing in clinical trials was based on the total amount of both components of sacubitril and valsartan tablets, i.e., 24/26 mg, 49/51 mg, and 97/103 mg were referred to as 50 mg, 100 mg, and 200 mg, respectively. 14. 1 Adult Heart Failure PARADIGM-HF PARADIGM-HF was a multinational, randomized, double-blind trial comparing sacubitril and valsartan tablets and enalapril in 8,442 adult patients with symptomatic chronic heart failure (NYHA class II to IV) and systolic dysfunction (left ventricular ejection fraction ≤ 40%) Patients had to have been on an ACE inhibitor or ARB for at least four weeks and on maximally tolerated doses of beta-blockers. Patients with a systolic blood pressure of less than 100 mmHg at screening were excluded The primary objective of PARADIGM-HF was to determine whether sacubitril and valsartan tablets, a combination of sacubitril and an RAS inhibitor (valsartan), was superior to an RAS inhibitor (enalapril) alone in reducing the risk of the combined endpoint of cardiovascular (CV) death or hospitalization for heart failure (HF) After discontinuing their existing ACE inhibitor or ARB therapy, patients entered sequential single-blind run-in periods during which they received enalapril 10 mg twice-daily, followed by sacubitril and valsartan tablets 100 mg twice-daily, increasing to 200 mg twice-daily Patients who successfully completed the sequential run-in periods were randomized to receive either sacubitril and valsartan tablets 200 mg (N = 4,209) twice-daily or enalapril 10 mg (N = 4,233) twice-daily.

The medications and brand names of Guideline-Directed Medical Therapy (GDMT) for Heart Failure (HF) mentioned in the study are:

• Sacubitril and valsartan tablets (no brand name mentioned in the text)
• Enalapril (no brand name mentioned in the text)
• Beta-blockers (no specific medication or brand name mentioned in the text)
• Mineralocorticoid antagonists (no specific medication or brand name mentioned in the text)
• Diuretics (no specific medication or brand name mentioned in the text) 2

From the Research

Guideline-Directed Medical Therapy (GDMT) for Heart Failure (HF)

The medications used in GDMT for HF include:

• Angiotensin Converting Enzyme Inhibitors (ACEi) 3, 4, 5, 6
• Angiotensin Receptor-Neprilysin Inhibitors (ARNI) 3, 4, 5, 6
• Beta-blockers (BB) 3, 4, 5, 6
• Mineralocorticoid Receptor Antagonists (MRA) 3, 4, 5, 6
• Angiotensin Receptor Blockers (ARB) 3, 4, 5, 6

Brand Names

Some brand names of these medications are:

• Sacubitril/valsartan (ARNI) 4, 5
• Enalapril (ACEi) 4
• Vericiguat (soluble guanylate cyclase stimulator) 5
• Elamipretide (myocardial energetics and mitochondrial function) 5
• Omecamtiv-mecarbil (myocardial contractility) 5

Medication Use

The use of these medications in GDMT for HF is supported by various studies, including the PARADIGM-HF trial 4, which compared the effectiveness of sacubitril/valsartan with enalapril in patients with HF and reduced ejection fraction. The results of this trial and others have led to the endorsement of sacubitril/valsartan as a class I recommendation for the management of symptomatic HF with reduced ejection fraction 4.

Real-World Data

Real-world data on the use of GDMT in HF patients has shown that many patients do not receive optimal therapy, with common causes of underprescription and underdosing including hypotension, bradycardia, kidney dysfunction, and hyperkalaemia 6. However, treatment with BB and ACEi/ARB/ARNI has been associated with a lower risk of death or HF hospitalizations 6.