ABSTRACT
Heart failure pharmacotherapy is the backbone of treatment plans for patients with heart failure. For patients with chronic heart failure, medications target neurohormonal modulation, symptom relief, or both. Neurohormonal modulators used to treat chronic heart failure include angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, an angiotensin receptor-neprilysin inhibitor, mineralocorticoid receptor antagonists, beta-blockers, the combination of isosorbide dinitrate and hydralazine, and vasopressin antagonists. With the exception of vasopressin antagonists, each of these medication classes has been associated with lower mortality in patients with heart failure with reduced ejection fraction. Diuretics, digoxin, and ivabradine are adjunctive medications used to reduced heart failure symptoms. In select patients hospitalized for heart failure, treatment with intravenous vasodilators, inodilators, and/or inopressors may be warranted to improve both hemodynamics and symptoms. This chapter reviews the pharmacology of each of these medication classes, highlighting mechanisms of action, important differences between drugs within each class, and safety concerns. This foundational knowledge will establish the appropriate use of these medications when treating patients with heart failure.
