From the Guidelines
The four main drug classes used to treat heart failure are ACE inhibitors (or ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors. These classes are prioritized based on their impact on morbidity, mortality, and quality of life. The most recent and highest quality study, 1, provides guidance on the management of heart failure, including the use of these four drug classes. Key points about each class include:
- ACE inhibitors like lisinopril, enalapril, and ramipril block the renin-angiotensin system, reducing blood pressure and cardiac workload.
- Beta-blockers including metoprolol succinate, carvedilol, and bisoprolol reduce heart rate and blood pressure, decreasing cardiac demand.
- MRAs like spironolactone and eplerenone block aldosterone, reducing fluid retention and fibrosis.
- SGLT2 inhibitors such as dapagliflozin and empagliflozin promote glucose excretion, reduce cardiac preload, and improve metabolic efficiency. These medications are typically started at low doses and gradually increased as tolerated, with regular monitoring of kidney function, electrolytes, and blood pressure, as recommended by 1. The combination of these four drug classes forms the cornerstone of modern heart failure management, as they work through complementary mechanisms to reduce symptoms, prevent hospitalizations, and improve survival, as supported by 1.
From the Research
Drug Classes for Heart Failure Treatment
The following are the four main drug classes used to treat heart failure:
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor-neprilysin inhibitors (ARNI) 2, 3
- Beta-blockers 2, 4, 3
- Mineralocorticoid receptor antagonists (MRA) 2, 4, 3
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as dapagliflozin or empagliflozin 3
Key Considerations
When selecting a treatment plan, clinicians should consider the following factors:
- Results from clinical trials in specific patient populations 2
- Adverse-event profiles 2, 4, 5
- Tolerability 2, 5
- Cost 2
- Dosing regimens 2
Treatment Initiation
Treatment initiation of all four drug classes should be fast and simultaneous, with individualized treatment plans based on patient needs 3. In some cases, the ARNI sacubitril/valsartan may be initiated even in ACE inhibitor-naïve patients 3.