Medications for HFpEF

The good news is that there are now more treatments for heart failure with preserved ejection fraction (HFpEF) than ever before. And the right combination of these medicines can help you feel better, stay out of the hospital and live longer.

Medications can:

• Help the heart pump better
• Ease the symptoms of heart failure, such as fluid buildup or shortness of breath
• Slow how quickly the disease progresses (gets worse)
• Treat blood pressure, chest pain and heart rhythm problems that can make your heart failure worse

Below is a list of some common medications used, and how each one works. Many of these medications work together and give added benefits.

The two mainstay medicines include:

• Sodium-glucose cotransporter 2 (SGLT2) inhibitors – originally used to treat diabetes, these medicines have clear benefits for people with heart failure according to studies. For example, fewer heart-related deaths and hospitalizations, and often people report feeling better. Common ones for HFpEF include dapagliflozin (Farxiga) and empagliflozin (Jardiance), with others being studied.
• Diuretics (like furosemide, bumetanide, torsemide) to help get rid of excess water (fluid buildup) in the body. Sometimes more than one water pill is needed.

Additional medicines are usually added and may include:

• Angiotensin receptor-neprilysin inhibitor (ARNI) – sacubitril/valsartan (Entresto) – is a combination of an ARB and a medicine that inhibits the production of neprilysin, an enzyme. This enzyme breaks down natural substances in the body that widen blood vessels and reduce sodium retention. The effect is to lower blood pressure and decrease strain on the heart. 
• Mineralocorticoid receptor antagonist (spironolactone) helps your body get rid of extra salt and water through the urine. It also blocks the effects of aldosterone, a hormone that tells your body to hold on to salt and water.
• Angiotensin II receptor blockers (ARBs) (like candesartan, losartan, valsartan) help relax your blood vessels and reduce strain on your heart and improve blood flow. They also lower blood pressure.
• Nonsteroidal MRA (finerenone) – recently FDA-approved, works by blocking  mineralocorticoid receptors (MR) in the heart and kidneys to reduce harmful scarring and thickening of the heart muscle that can cause it to stiffen.
• Anti-obesity drugs, if overweight, which can improve symptoms and exercise capacity. 

Medication Tips

• Always take your medication as directed.
• Be sure you understand why each medicine is recommended and how it helps.

  You may start taking a medication at a low dose (amount). Your clinician will gradually increase the dose based on how you are doing.

• Review all of the medications you take, including any over-the-counter medicines or supplements, at each visit to make sure you are on the best medications, and to check the amount (dose) of each.
• Tell your care team or pharmacist if you have concerns about side effects or how a medicine makes you feel or if you have trouble remembering to take them or paying for them.

Be Sure to Manage Other Conditions

Many people with HFpEF have:

• Unhealthy weight
• High blood pressure
• Diabetes
• Atrial fibrillation
• Kidney disease
• Sleep apnea

All of these can make HFpEF worse if they aren’t well treated. Making sure they are well managed can help you feel a lot better.