Medications Used in Treatment of Heart and Vascular Disease

Angiotensin converting enzyme (ACE) inhibitors reduce the production of the enzyme angiotensin, which makes blood vessels constrict. ACE inhibitors allow blood vessels to expand so that blood can flow more easily and the heart can work more efficiently. These medications may be used for controlling high blood pressure, treating heart failure, or preventing strokes. Examples of commonly prescribed ACE inhibitors are benazepril, captopril, enalapril, and lisinopril. ACE inhibitors should not be taken by pregnant women, as they present a risk of birth defects.

Angiotensin II receptor blockers (ARBs) block the effects of the enzyme angiotensin, which causes blood vessels to constrict. These medications are used to control high blood pressure, treat heart failure, or prevent strokes. They are often prescribed to patients who do not tolerate ACE inhibitors well. Examples of commonly prescribed angiotensin II receptor blockers are candesartan, losartan, telmisartan, valsartan, and others. ARBs should not be taken by pregnant women, as they present a risk of birth defects.

Alpha blockers treat high blood pressure by prohibiting the production of a hormone that makes the blood vessels constrict. Examples of alpha blockers are doxazosin, prazosin, and terazosin.

Antiarrhythmics include several categories of medicines that correct and prevent irregular heartbeats. Beta-blockers are antiarrhythmic medicines that make the heart beat slower. Calcium-channel blockers are sometimes used as antiarrhythmics, blocking nerve impulses that may make the heart beat faster. Potassium-channel blockers are antiarrhythmic agents that slow heartbeat rates by blocking potassium channels in the heart. Sodium-channel blockers help to reduce heartbeat rates by slowing electrical conduction in the heart.

Antibiotics are used to gain control of an infection of the heart (bacterial pericarditis) before damage occurs. Patients receive strong doses of antibiotics (often intravenously) over the course of several weeks.

Anticoagulant medications (blood thinners) are used to prevent the blood from clotting (e.g., Coumadin, heparin, and Warfarin). They are used to prevent heart attacks or strokes, or to treat deep vein thrombosis or pulmonary embolism.

Antihyperlipidemics include several types of medications that lower fat levels in the blood by lowering levels of low-density lipoprotein (LDL) cholesterol or reducing triglyceride levels. Reducing these fats helps to prevent the development of atherosclerosis, a major contributor to heart disease. Some may also help raise the levels of high-density lipoprotein (HDL) cholesterol.

Anti-inflammatory medications, also called non-steroidal anti-inflammatories (NSAIDs), may be used to reduce pain, control inflammation of the heart and blood vessels, and prevent blood clots. Ibuprofen is an anti-inflammatory that may be prescribed to control the inflammation associated with endocarditis. For patients with heart disease, low-dose aspirin may be used to reduce the risk of heart attack and stroke. NSAIDs are typically well tolerated, but chronic use may lead to kidney failure.

Antiplatelet medications, such as aspirin, work against clotting by making blood platelets less likely to stick together. This type of medication is often prescribed to reduce the risk of heart attack and stroke. Aspirin is typically well tolerated, but chronic use may lead to kidney failure.

Antiproliferative agents are anti-cancer drugs that may have a role in the treatment of pulmonary hypertension by reducing abnormal growth of the cells that line the lung arteries.

Beta-blockers are antiarrhythmic medicines that make the heart beat slower and with less force by reducing nerve impulses to the heart and blood vessels. They may be used for treating arrhythmias, high blood pressure, heart failure, or angina, or to help prevent further heart attacks.

Bile acid sequestrants lower LDL cholesterol, although somewhat less effectively than statins. These medications work by binding with bile acids in the intestines and forcing them to be eliminated in the stool rather than absorbed. As more bile is lost, more cholesterol from the body is used up to make additional bile. Reducing LDL cholesterol helps to prevent the development of atherosclerosis, a major contributor to heart disease. The most common side effects of bile acid sequestrants are gastrointestinal, such as constipation, vomiting, or diarrhea.

Calcium-channel blockers cause blood vessels to dilate or widen, thereby reducing hypertension, by reducing the calcium concentration in their cells. Some of these medicines are also used as antiarrhythmics, blocking nerve impulses that may make the heart beat faster.

Cilostazol is a medication that improves blood flow in the legs. Cilostazol helps to reduce leg pain while walking for patients with peripheral vascular disease.

Digoxin increases heartbeat strength and can be used to treat congestive heart failure or heart rhythm problems.

Diuretics help lower blood pressure by helping the body remove excess fluid that may accumulate in tissues due to high blood pressure. A diuretic is often the first type of medication that doctors prescribe for reducing high blood pressure.

Endothelin receptor antagonists are used to open up the blood vessels in the lung. They can be helpful for patients with pulmonary arterial hypertension.

Fibrates (gemfibrozil, fenofibrate) are sometimes used to reduce the risk of atherosclerosis, which often leads to heart disease. They are most effective for their ability to lower triglyceride levels. They may also lead to modest improvements in LDL cholesterol and HDL cholesterol levels.

Nicotinic acid (niacin) is a B vitamin that increases HDL cholesterol and lowers LDL cholesterol and triglycerides when taken at levels higher than dietary requirements. Taking nicotinic acid helps reduce the risk of developing atherosclerosis.

Nitric oxide pathway enhancers (phosphodiesterase-5 inhibitors and soluble guanyl-cyclase stimulators) enhance the effects of nitric oxide, which is a potent vasodilator (substance that expands blood vessels). It is used to treat patients with high blood pressure.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to reduce heart inflammation in patients with endocarditis or help reduce the risk of heart attack or stroke. They can reduce pain, control inflammation of the heart and blood vessels, and prevent blood clots.

Potassium-channel blockers are antiarrhythmic agents that slow heartbeat rates by blocking potassium channels in the heart. These medicines may also be used to lower blood pressure by dilating blood vessels.

Prostacyclin analogues help to open up the blood vessels in the lungs and to prevent the abnormal platelet production that leads to clots. These drugs may be given through an infusion or as an inhaled therapy for patients with pulmonary hypertension.

Sodium-channel blockers help to reduce abnormally fast heartbeat rates by slowing electrical conduction in the heart.

Statins simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol) help lower LDL cholesterol and/or triglycerides, thereby reducing the risk of developing atherosclerosis and heart disease. The most common side effects of statins are headache, nausea, vomiting, gastrointestinal issues, rash, weakness, and muscle pain.

Thrombolysis describes the use of medication (streptokinase, t-PA) to dissolve blood clots (often referred to as clot-busting medication) in the pulmonary artery or deep leg veins. These medications can be used alone or with other interventional procedures.

Vasodilators widen blood vessels and improve blood flow (lower blood pressure) by relaxing the muscle in the heart and vessel walls.