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Thursday, 25 June 2015

Three-drug regimen works best for treating heart failure

DEAR READERS: Yesterday, I answered a question about treatments for heart failure. It’s a big topic, and so today I’m talking about the medicines that are typically used to treat heart failure.



As we discussed, heart failure is a condition in which the heart cannot pump efficiently enough to meet the body’s need for blood. As a result, tissues and organs throughout the body don’t get enough oxygen. Also, fluid builds up in the lungs and other body tissues.

Taking heart failure medicines as prescribed is perhaps the single most important thing you can do to feel better and live longer. The medicines available today are dramatically more potent than the medicines that were available when I was in medical school.

Most people with heart failure need a three-drug regimen. This includes a diuretic, a beta blocker, and an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB).

Diuretics are also called water pills. They help the kidneys eliminate the excess sodium and water that builds up because of heart failure. This reduces blood volume, blood pressure, swelling and congestion.

Beta blockers reduce the heart’s workload. At times of stress and during exercise, nerve cells release hormones that stimulate the heart. One such hormone is adrenaline. At first, these hormones cause the heart to pump both faster and more forcefully, giving a brief boost to the performance of a failing heart. But when persistently high levels of adrenaline keep “whipping” the heart muscle to work harder, the muscle becomes exhausted. Beta blockers reduce the stimulation of the heart, slow the heart rate, lower blood pressure and decrease the heart’s workload. When the heart is not being constantly whipped to pump faster and harder, it pumps more efficiently.

ACE inhibitors and ARBs relax blood vessels. They work on the renin-angiotensin-aldosterone system. This is an intricate system that links the brain, heart and kidneys via hormones in the blood. (These hormones are different from adrenaline.) The renin-angiotensin-aldosterone system regulates blood pressure.

In a person with heart failure, the heart’s weak pumping activates the renin-angiotensin-aldosterone system. This raises the amount of fluid and sodium in the blood and blood pressure, creating extra work for the already weakened heart. ACE inhibitors and ARBs calm down the renin-angiotensin-aldosterone system, relaxing blood vessels and relieving high blood pressure.

On my website, AskDoctorK.com, I’ve put a table listing the names, actions and possible side effects of drugs in each of these categories.

Two other types of medicines are sometimes used to treat heart failure: aldosterone blockers and digoxin. Aldosterone blockers are another class of drugs that act on the renin-angiotensin-aldosterone system. Digoxin boosts the strength of the heart’s contractions. It used to be the main drug used to treat heart failure, but it was not as potent as the newer drugs and had more serious possible side effects.

In addition, research is developing exciting possible new treatments, particularly a drug called an angiotensin receptor-neprilysin inhibitor.

Source : elkodaily

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