First-Line & Second-Line Pharmacotherapy of Heart Failure: Czairah Lhei M. Valenzuela

FIRST-LINE &
SECOND-LINE
PHARMACOTHERAPY
OF HEART FAILURE
CZAIRAH LHEI M. VALENZUELA
FIRST-LINE
PHARMACOTHERAPY
OF HEART FAILURE
• ACE inhibitors, ARBs or angiotensin receptor
blockers, beta-blockers, MRAs or
mineralocorticoid receptor antagonist and
diuretics form the basis of first-line pharmacological
management of left ventricular systolic heart failure.
• Treatment doses should be increased to those shown

to be of benefit in the major trials or to the highest
tolerated doses.
• Greater benefits in morbidity are achieved with the
recommended target doses.
FIRST-LINE
PHARMACOTHERAPY
OF HEART FAILURE
ACE inhibitors
• ACE inhibitors dilate the blood vessels to improve

your blood flow. This helps decrease the amount of
work the heart has to do.
• They also help block a substance in the blood called

angiotensin that is made as a result of heart failure.
• ACE inhibitors are critical in the treatment of heart

failure. They are also used to control high blood
pressure, prevent kidney damage from diabetes, and
prevent more heart damage after a heart attack.
FIRST-LINE
PHARMACOTHERAPY
OF HEART FAILURE
ACE inhibitors
Examples of them include:
• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Zestril)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik)
FIRST-LINE
PHARMACOTHERAPY
OF HEART FAILURE
ARBs or Angiotensin Receptor Blockers
• Angiotensin Receptor Blockers are recommended as an

alternative for patients who experience ACE inhibitor-
mediated adverse effects such as a cough. ARBs are generally
better tolerated than ACE inhibitors due to the absence of
kinin-mediated side effects.
• ARBs provide mortality and morbidity benefits in patients

with left ventricular systolic heart failure. The body of
evidence for ACEI or Angiotensin Converting Enzyme Inhibitor
is greater than for ARBs.
FIRST-LINE
PHARMACOTHERAPY
OF HEART FAILURE
Beta Blockers
• Beta-blockers should only be initiated after a patient’s

condition has established to avoid precipitating Heart Failure
decompensation. They are often commenced in hospital with
a plan for up-titration every 2-4 weeks until the target dose is
reached.
• The decision regarding which HF-specific beta-blocker should
be prescribed is influenced by the patient’s co-morbidities
and prescriber familiarity.
• Beta blockers, also known as beta-adrenergic blocking agents,
are medications that reduce blood pressure. Beta blockers
work by blocking the effects of the hormone epinephrine,
also known as adrenaline.
FIRST-LINE
PHARMACOTHERAPY
OF HEART FAILURE
Examples of beta blockers taken by mouth include:
• Acebutolol
• Atenolol (Tenormin)
• Bisoprolol (Zebeta)
• Metoprolol (Lopressor, Toprol XL)
• Nadolol (Corgard)
• Nebivolol (Bystolic)
• Propranolol (Inderal, InnoPran XL)
FIRST-LINE
PHARMACOTHERAPY
OF HEART FAILURE
MRAs or Mineralocorticoid Receptor Antagonist
• Spironolactone reduces mortality and symptoms in patients

with advanced Heart Failure.
• Eplerenone reduces mortality in left ventricular systolic
• Heart failure patients who still have mild symptoms despite
receiving ACEI and beta-blocker therapy, or in the immediate
post-MI period when left ventricular systolic dysfunction is
identified.
• The choice of MRA is influenced by the severity of LV systolic
dysfunction, the presence of recent myocardial infarction, the
presence or likelihood of MRA-related adverse effects such as
gynacomastia and eligibility for a healthcare subsidy.
SECOND-LINE
PHARMACOTHERAPY
OF HEART FAILURE
Angiotensin Receptor Neprilysin Inhibitors (ARNI)
• Angiotensin Receptor Neprilysin Inhibitor (ARNI) combines the

neprilysin inhibitor (sacubitril) with the angiotensin receptor
blockade (valsartan).
• Sacubitril/valsartan (trade name Entresto) has been shown to
be superior to the ACE inhibitor (enalapril) in reducing
cardiovascular mortality and hospitalization due to left
ventricular systolic heart failure.
SECOND-LINE
PHARMACOTHERAPY
OF HEART FAILURE
Sacubitril/valsartan is recommended as a replacement for

an ACE inhibitor or an ARB. Indications include:
• Symptomatic with NYHA class II-IV

• Be on concomitant optimal standard heart failure treatment
that includes maximum tolerated dose of beta blocker (unless
contraindicated)
• Be stablished on an ACE inhibitor or ARB (unless
contraindicated)
SECOND-LINE
PHARMACOTHERAPY
OF HEART FAILURE
Ivabradine
• is used to treat adults who have chronic heart failure to

reduce their risk of hospitalization for worsening heart failure.
It is also used to treat heart failure in children 6 months of
age and older who have stable heart failure, with symptoms,
caused by an enlarged heart (dilated cardiomyopathy).
Digoxin
• is used to treat congestive heart failure, usually in

combination with a diuretic (water pill) and an angiotensin-
converting enzyme (ACE) inhibitor. It is also used to treat a
heart rhythm problem called atrial fibrillation.
SECOND-LINE
PHARMACOTHERAPY
OF HEART FAILURE
Hydralazine-isosorbide dinitrate
• Hydralazine-isosorbide dinitrate combination should be

considered in patients who are actually intolerant of ACE
inhibitors and ARBs or for whom these agents are
contraindicated.
Iron infusions
• Iron supplementation for iron deficiency

T H A N K YOU!

First-Line & Second-Line Pharmacotherapy of Heart Failure: Czairah Lhei M. Valenzuela

Uploaded by

Copyright:

Available Formats

First-Line & Second-Line Pharmacotherapy of Heart Failure: Czairah Lhei M. Valenzuela

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

First-Line & Second-Line Pharmacotherapy of Heart Failure: Czairah Lhei M. Valenzuela

Uploaded by

Copyright:

Available Formats

FIRST-LINE &

• Treatment doses should be increased to those shown

• ACE inhibitors dilate the blood vessels to improve

• They also help block a substance in the blood called

• ACE inhibitors are critical in the treatment of heart

Examples of them include:

• Angiotensin Receptor Blockers are recommended as an

• ARBs provide mortality and morbidity benefits in patients

• Beta-blockers should only be initiated after a patient’s

Examples of beta blockers taken by mouth include:

MRAs or Mineralocorticoid Receptor Antagonist

• Spironolactone reduces mortality and symptoms in patients

Angiotensin Receptor Neprilysin Inhibitors (ARNI)

• Angiotensin Receptor Neprilysin Inhibitor (ARNI) combines the

Sacubitril/valsartan is recommended as a replacement for

• Symptomatic with NYHA class II-IV

• is used to treat adults who have chronic heart failure to

• is used to treat congestive heart failure, usually in

• Hydralazine-isosorbide dinitrate combination should be

• Iron supplementation for iron deficiency

You might also like