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Risks and Benefits of Medicines for Heart Failure

Topic Overview

Heart failure is a very serious illness that can cause life-threatening complications and significantly limit your life span. Fortunately, many drugs have been shown to slow the progression of heart failure, and several drugs have been shown to prolong survival. Each of these medicines has risks and benefits that you and your doctor will need to weigh when you are deciding whether you should take the medicine.

How do medicines relieve symptoms?

Medicines for heart failure help relieve symptoms by:

  • Removing excess fluid from the body. The class of medicines known as diuretics acts mainly to rid the body of excess fluid.
  • Improving the ability of the heart to pump more effectively. Another type of medicine, digoxin, works mainly by increasing the strength of the contraction of the heart.
  • Preventing further injury to the heart. A class of medicines known as angiotensin-converting enzyme (ACE) inhibitors acts both by improving the efficiency of pumping and by preventing further damage to the heart.

How do medicines prolong survival?

Several medicines may help increase the life span of people who have heart failure. These include:

  • ACE inhibitors.
  • ARBs (angiotensin II receptor blockers).
  • Beta-blockers.
  • Aldosterone receptor antagonists, which are a type of diuretic. (Other types of diuretics can improve symptoms but do not improve survival.)

The exact mechanism by which these medicines prolong survival is not entirely clear. Each medicine might have several beneficial effects for people with heart failure. In terms of prolonging survival, the most important effects may be the ability of these drugs to prevent both lethal abnormal heart rhythms and their ability to limit ongoing damage to the heart.

Benefits and risks of heart failure drugs

Drug or class of drugs



ACE inhibitors
  • Inhibit adverse effects of angiotensin II on the heart and blood vessels
  • Reduce heart failure symptoms
  • Prolong survival
  • Low blood pressure
  • Soft tissue swelling of the face and throat, and hives (severe allergy)
  • Dry cough
  • Reduced kidney function
  • Increased potassium
  • Reduce heart failure symptoms
  • Prolong survival
  • Prevent ventricular arrhythmia
  • Slow heart rate improves diastolic heart failure.
  • Heart rate too slow


  • Reduce fluid buildup in the lungs and legs
  • Reduce heart failure symptoms
  • Prolong survival (aldosterone receptor antagonists)
  • Low blood pressure
  • Reduced kidney function if too much fluid removed
  • Low or high potassium, magnesium, calcium
  • Decreased heart failure symptoms
  • Reduced need for hospitalization
  • Heart rate too slow
  • Dangerous arrhythmias if level too high
Calcium channel blockers
  • Help your heart fill with blood more easily.
Angiotensin II receptor blockers (ARBs)
  • Inhibit adverse effects of angiotensin II on the heart and blood vessels
  • Reduce heart failure symptoms
  • Prolong survival
  • Low blood pressure
  • High potassium
  • Vasodilatation
  • Reduce heart failure symptoms
  • Reduce heart failure symptoms and lower risk of early death when used in combination with a nitrate
  • Low blood pressure
  • Relieve angina (chest pain or discomfort)
  • Reduce heart failure symptoms and lower risk of early death when used in combination with hydralazine

Tailor the decisions you make with your doctor to meet your own personal goals of treatment for your heart failure. Some decisions are not always completely right or wrong. What is most important is that you make informed decisions that are right for you and with which you are comfortable.

In fact, your goals of treatment may change over time. Early in the course of your treatment, you may want to do everything possible to extend your life span, even if it means making your symptoms temporarily worse. A good example of this is starting therapy with a beta-blocker, which can make your symptoms worse during the first few weeks or months but eventually may reduce your symptoms and prolong your survival.

But if you develop end-stage heart failure with very severe symptoms that prevent you from doing even simple activities, you may prefer treatments that are most effective at reducing your symptoms, even if they may have some risk of decreasing your survival.

To help you with decision making, the most important things you can do are: first, keep yourself well informed about the risks and benefits of the treatments that are available to you, and second, work closely with a doctor whose advice and opinions you trust.


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