From the Guidelines
Cardiovascular medications can be broadly classified into several categories, including antihypertensives, antianginals, antiarrhythmics, anticoagulants, antiplatelets, lipid-lowering agents, and heart failure medications, with the most effective reduction of blood pressure and cardiovascular disease events achieved with ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics as first-line treatments, as recommended by the 2024 ESC guidelines 1. The classification of cardiovascular medications is crucial for the management of various cardiovascular conditions.
- Antihypertensives, such as ACE inhibitors (lisinopril, enalapril), ARBs (losartan, valsartan), calcium channel blockers (amlodipine, diltiazem), diuretics (hydrochlorothiazide, furosemide), and beta-blockers (metoprolol, atenolol), are used to lower blood pressure and reduce the risk of cardiovascular disease events.
- Antianginals, including nitrates (nitroglycerin), beta-blockers, and calcium channel blockers, help manage chest pain.
- Antiarrhythmics, such as sodium channel blockers (lidocaine), beta-blockers, potassium channel blockers (amiodarone), and calcium channel blockers, regulate heart rhythm.
- Anticoagulants and antiplatelets, including warfarin, heparin, DOACs (apixaban, rivaroxaban), aspirin, and clopidogrel, prevent blood clots.
- Lipid-lowering agents, such as statins (atorvastatin, simvastatin), fibrates (fenofibrate), and PCSK9 inhibitors (evolocumab), reduce cholesterol levels.
- Heart failure medications, including ACE inhibitors, beta-blockers, aldosterone antagonists (spironolactone), and newer agents like SGLT2 inhibitors (empagliflozin) and ARNIs (sacubitril/valsartan), improve outcomes in heart failure patients. According to the 2024 ESC guidelines, the recommended first-line treatments for hypertension are ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics, which have demonstrated the most effective reduction of blood pressure and cardiovascular disease events 1. In addition, beta-blockers are recommended to be combined with any of the other major blood pressure-lowering drug classes when there are other compelling indications for their use, such as angina, post-myocardial infarction, heart failure with reduced ejection fraction, or for heart rate control 1. The guidelines also recommend fixed-dose single-pill combination treatment for patients receiving combination blood pressure-lowering treatment, and increasing to a three-drug combination if blood pressure is not controlled with a two-drug combination, usually a RAS blocker with a dihydropyridine CCB and a thiazide/thiazide-like diuretic, and preferably in a single-pill combination 1. Overall, the classification and selection of cardiovascular medications should be based on the most recent and highest quality evidence, such as the 2024 ESC guidelines, to improve outcomes in patients with cardiovascular disease.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
CVS Medication Classification
The classification of CVS (Cardiovascular) medications involves various categories, including:
- Angiotensin-Converting Enzyme Inhibitors (ACEIs)
- Angiotensin Receptor Blockers (ARBs)
- Calcium Channel Blockers (CCBs)
- Diuretics
- Beta-Blockers
ACEIs and ARBs
ACEIs and ARBs are commonly used to treat hypertension and heart failure. Studies have shown that:
- ACEIs are effective in reducing mortality and morbidity in patients with hypertension and heart failure 2, 3
- ARBs are equally effective as ACEIs in reducing blood pressure and cardiovascular events, but with fewer adverse effects 4, 5, 6
- ACEIs are associated with a higher risk of cough and angioedema compared to ARBs 4, 5
Calcium Channel Blockers
CCBs are used to treat hypertension, angina, and arrhythmias. Studies have shown that:
- CCBs are effective in reducing blood pressure and cardiovascular events, but may not be as effective as ACEIs or ARBs in reducing mortality and morbidity 2, 3
- CCBs are contraindicated in patients with congestive heart failure due to systolic dysfunction 2
Diuretics and Beta-Blockers
Diuretics and beta-blockers are also used to treat hypertension and heart failure. Studies have shown that:
- Diuretics are effective in reducing blood pressure and cardiovascular events, and are often used as first-line therapy 2
- Beta-blockers are effective in reducing mortality and morbidity in patients with heart failure, and are often used in combination with ACEIs or ARBs 2, 6
Comparison of CVS Medications
A comparison of the different CVS medications shows that:
- ACEIs and ARBs are equally effective in reducing blood pressure and cardiovascular events, but ACEIs are associated with more adverse effects 4, 5, 6
- CCBs are effective in reducing blood pressure and cardiovascular events, but may not be as effective as ACEIs or ARBs in reducing mortality and morbidity 2, 3
- Diuretics and beta-blockers are effective in reducing blood pressure and cardiovascular events, and are often used as first-line therapy or in combination with ACEIs or ARBs 2, 6