02 Cardiovascular Medications
Review major cardiovascular medication classes, their common indications, distinguishing features, and important safety considerations.
Medications for hypertension
Antihypertensives lower blood pressure by reducing vascular resistance, blood volume, or cardiac workload. Common classes include diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta blockers. The examples below use familiar U.S. brand names, but availability and marketed brands can change; focus on each generic name, class, and major indication. This is a study reference, not a guide to choosing or changing treatment.
ACE inhibitors: Lisinopril (Zestril, Prinivil) and enalapril (Vasotec) are used for hypertension and also for heart failure. They can cause cough and hyperkalemia.
ARBs: Losartan (Cozaar) and valsartan (Diovan) are used for hypertension and are often used when an causes cough. They can cause hyperkalemia.
Dihydropyridine calcium channel blocker: Amlodipine (Norvasc) treats hypertension and and may cause peripheral edema.
Non-dihydropyridine calcium channel blockers: Diltiazem (Cardizem) and verapamil (Calan, Verelan) treat hypertension, , and selected arrhythmias. They slow AV-node conduction and heart rate.
Thiazide-type diuretics: Chlorthalidone and hydrochlorothiazide (Microzide) treat hypertension and may lower potassium and sodium.
Loop diuretic: Furosemide (Lasix) removes excess fluid and is commonly used for edema in heart failure. It is not usually a first-line drug for uncomplicated hypertension.
and potassium-sparing diuretic: Spironolactone (Aldactone) is used for resistant hypertension and heart failure and can raise potassium.
Beta blockers: Metoprolol (Lopressor, Toprol-XL) and carvedilol (Coreg) lower heart rate and workload. They are used for selected hypertension, , arrhythmias, and heart failure; carvedilol also blocks alpha receptors.
ACE inhibitors commonly end in -pril, while ARBs commonly end in -sartan. ACE inhibitors and ARBs are generally not combined. Beta blockers are important for specific indications but are not the default first choice for uncomplicated hypertension.
Medications for
Antianginal medications reduce myocardial oxygen demand, improve coronary blood flow, or both. Beta blockers and calcium channel blockers are common long-term symptom-control options. Nitrates relieve or prevent , while ranolazine is used for chronic .
Nitroglycerin (Nitrostat, Nitro-Dur): This nitrate vasodilator treats an acute episode when given sublingually and can also be used before a predictable trigger. Long-acting forms help prevent episodes. It may cause headache and hypotension.
Isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil): These nitrates are used for longer-term prevention of . They are not substitutes for sublingual nitroglycerin during an acute episode.
Metoprolol (Lopressor, Toprol-XL): This beta blocker reduces heart rate and cardiac workload and is used for chronic .
Amlodipine (Norvasc) and diltiazem (Cardizem): These calcium channel blockers treat by relaxing vessels; diltiazem also slows heart rate.
Ranolazine (Ranexa): Used for chronic , it is not for immediate relief of an acute attack.
Nitrates can cause a dangerous blood-pressure drop when combined with phosphodiesterase-5 inhibitors such as sildenafil.
Medications for heart failure
For heart failure with reduced ejection fraction (), foundational medication groups are an ARNI or, when appropriate, an or ; an evidence-based beta blocker; a ; and an SGLT2 inhibitor. The specific regimen depends on the patient and clinical circumstances.
ARNI: Sacubitril/valsartan (Entresto) combines neprilysin inhibition with an and is used for . It must not be taken with an ; a washout period is required when switching.
or : Lisinopril (Zestril) or valsartan (Diovan) may be used as alternative renin–angiotensin system therapy in heart failure when an ARNI is not used.
Evidence-based beta blockers: Carvedilol (Coreg), metoprolol succinate (Toprol-XL), and bisoprolol (Zebeta) improve outcomes in chronic . These specific agents are commonly tested.
Mineralocorticoid receptor antagonists: Spironolactone (Aldactone) and eplerenone (Inspra) are used for ; monitor potassium and kidney function.
SGLT2 inhibitors: Dapagliflozin (Farxiga) and empagliflozin (Jardiance) reduce heart-failure risk in eligible patients, including many without diabetes.
Loop diuretics: Furosemide (Lasix) and bumetanide (Bumex) reduce edema and pulmonary congestion and primarily relieve symptoms.
Digoxin (Lanoxin): This cardiac glycoside may improve symptoms in selected heart-failure patients and also slows ventricular rate in some patients with atrial fibrillation. It has a narrow therapeutic range.
Hydralazine/isosorbide dinitrate (BiDil): This combination of an arterial vasodilator and a nitrate is used for selected patients with , including those who cannot use ACE inhibitors, ARBs, or ARNIs.
Diuretics improve congestion, while the foundational therapies also target disease progression and clinical outcomes.
Medications for arrhythmias
Antiarrhythmics can control heart rate, restore or maintain rhythm, or terminate a specific tachycardia. Selection depends on the rhythm and the patient. These drugs can themselves worsen arrhythmias and often require monitoring.
Adenosine (Adenocard; generic IV): A very short-acting AV-nodal blocker used for acute conversion of certain regular paroxysmal supraventricular tachycardias (). It does not convert atrial fibrillation or atrial flutter to sinus rhythm.
Metoprolol (Lopressor, Toprol-XL): A beta blocker that slows AV-node conduction and is used for in selected tachyarrhythmias, including atrial fibrillation.
Diltiazem (Cardizem) and verapamil (Calan): These non-dihydropyridine calcium channel blockers slow AV-node conduction in selected supraventricular rhythms and can be used for .
Amiodarone (Pacerone, Cordarone): A class III-dominant antiarrhythmic used for selected serious ventricular arrhythmias and other rhythm disorders. Important risks include pulmonary, thyroid, liver, and drug-interaction effects.
Sotalol (Betapace): A class III antiarrhythmic with beta-blocking action used for selected atrial or ventricular arrhythmias. It can prolong QT and cause torsades de pointes.
Flecainide (Tambocor) and propafenone (Rythmol): These class Ic sodium-channel blockers are used for in selected atrial arrhythmias and are generally avoided in significant structural or ischemic heart disease.
Lidocaine (Xylocaine, IV): A class Ib sodium-channel blocker used mainly for selected ventricular arrhythmias, especially in acute-care settings.
Digoxin (Lanoxin): This cardiac glycoside slows AV-node conduction and can help control ventricular rate in selected atrial fibrillation cases; monitor for toxicity.
Metoprolol, diltiazem, verapamil, and sometimes digoxin primarily provide by slowing ventricular response. Flecainide, amiodarone, and similar drugs may be used for . Anticoagulants sometimes accompany atrial-fibrillation treatment to reduce stroke risk, but they do not correct the rhythm.
Lipid-lowering medications
Statins are the primary medication group for lowering cholesterol and reducing cardiovascular risk. Additional drugs may be used when more reduction is needed or when statins are not tolerated. Fibrates and prescription omega-3 products are used chiefly to lower high triglycerides.
Statins: Atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor) are HMG-CoA reductase inhibitors that lower and are common first-line therapy.
Ezetimibe (Zetia): An intestinal cholesterol-absorption inhibitor that lowers and is often added to a .
PCSK9 monoclonal antibodies: Evolocumab (Repatha) and alirocumab (Praluent) markedly lower and are injectable add-on therapies for selected patients.
Inclisiran (Leqvio): A PCSK9-targeting small interfering RNA that lowers by reducing PCSK9 production in the liver.
Bempedoic acid (Nexletol): An ATP-citrate lyase inhibitor and oral add-on option for lowering in selected patients.
Fibrates: Fenofibrate (Tricor) and gemfibrozil (Lopid) primarily lower triglycerides.
Icosapent ethyl (Vascepa): A prescription omega-3 fatty acid used for selected patients with elevated triglycerides and cardiovascular risk.
For quick class distinctions, statins lower , while fibrates chiefly lower triglycerides.