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Diuretics - Diuretics (e.g., Furosemide, Lasix, Bumex, Zaroxolyn) are used to stimulate the kidneys to pull excess fluid from the lungs, extremities, or abdomen and excrete the fluid as urine. These medications are used in persons who have fluid in the lungs and who experience shortness of breath or have swollen legs. This therapy is useful in persons with both systolic and diastolic dysfunction. Routine monitoring of the blood includes potassium and sodium levels as well as kidney function which may be affected by these medications. Diuretics provide relief of symptoms but do not decrease mortality.

Angiotensin converting enzyme (ACE) inhibitors - ACE inhibitors (e.g., captopril, enalapril) are drugs that block the renin-angiotensin system. They lower blood pressure and make it easier for blood to leave the heart. A new category of medications is the ACE receptor blockers, which block the renin-angiotensin system at a different site. Studies are being done to determine if these drugs are as effective as ACE inhibitors. These are usually not used for patients with diastolic dysfunction. A small percentage of patients develop a persistent cough when started on ACE inhibitors. These patients may be switched to ACE receptor blockers which do not cause this side-effect. Both the ACE inhibitors and the ACE receptor blockers must be used with care in persons who have significant kidney disease.

Beta blockers (e.g., metoprolol)- Heart failure activates the sympathetic nervous system and causes more adrenaline-like substances to accumulate in the blood. This makes the heart work harder and beat faster, and can lead to dangerous arrhythmias. Beta blockers prevent this by causing the heart not to work as hard or as fast. Heart rate must be monitored occasionally to be sure the heart rate is not being slowed too much (bradycardia).

Newer Beta blockers (e.g., Carvedilol, Bucindolol) - These medications block the sympathetic activity, dilate the arteries, and decrease blood pressure.

Nitroglycerin (paste or patch) - Although nitroglycerin is used mainly for patients with chest pain (angina), it can also be used to treat heart failure because it dilates the veins of the body forcing blood to pool away from the heart.

Hydralazine and Isordil - This combination of medications decreases blood pressure and is an option when ACE inhibitors cannot be used because of the presence of kidney disease. This combination of medications is not quite as effective as the ACE inhibitors but definitely offers benefit and help to prolong survival. Studies have shown that these two medications are effective in African American patients with CHF and are approved and marketed as a combination drug (BiDil).

Spironolactone (e.g., Aldactone) - Spironolactone, an aldosterone receptor blocking agent, has been used for many years as a diuretic. Recent studies have shown an additional direct effect on the heart, which increases survival when given in addition to other medications such as the beta blockers and ACE inhibitors. Potassium levels must be monitored periodically while using this medication.

Ionotropic Agents - Drugs that strengthen the contraction of the heart are known as ionotropic agents. These include digitalis (e.g., Digoxin) as well as newer drugs called phosphodiesterase inhibitors, such as milrinone (Primacor). Dobutamine is another ionotropic agent that is sometimes administered by intravenous drip for 72 hours every three or four weeks to improve symptoms of congestive heart failure in severe cases. These medications, however, are not useful in persons with diastolic dysfunction. Digitalis has not been shown to decrease mortality but may improve symptoms.