Medication options for systolic heart failure include beta-blockers, ACE inhibitors, ARBs, and ARNis. Their goal is to reduce the burden on your heart and interrupt the chemicals that can weaken your heart.

Systolic heart failure is a condition in which your heart doesn’t pump as it should. If your left ventricle doesn’t contract well enough, you may have systolic heart failure. Symptoms of systolic heart failure include fatigue, shortness of breath, weight gain, and coughing.

If you’ve received a diagnosis of systolic heart failure, you likely have a lot of questions about the condition and how it’s treated. This article provides answers to commonly asked questions. Consider using these points as a guide to start discussions with your doctor.

Systolic heart failure needs to be treated with several types of medication. The goal of therapy for this type of heart failure is to reduce the burden on your heart and interrupt the chemicals that can weaken your heart over time. In turn, your heart should work more efficiently and your quality of life should improve.

Beta-blockers (beta-adrenergic blocking agents)

These medications are useful for slowing heart rate, reducing blood pressure, decreasing the force of your heart’s contractions, and even reversing heart damage. They work by blocking beta receptors, which can be stimulated by epinephrine or norepinephrine.

Channel blockers (or inhibitors)

This drug class works in the same way as beta-blockers, reducing or slowing your heart rate. The only approved drug in this class is Ivabradine (Corlanor).

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin is a hormone that your body produces. It stabilizes circulation by narrowing blood vessels. This raises your blood pressure.

If your heart is generally healthy, angiotensin helps make sure your blood pressure doesn’t get too low. But when you have heart failure, angiotensin regulation is disturbed and levels can be excessive.

In systolic heart failure, lowering your blood pressure can reduce the burden on your heart. ACE inhibitors interrupt angiotensin-converting enzyme, which relaxes blood vessels and reduces fluid retention. This lowers your blood pressure and lets your heart rest so that it doesn’t have to work as hard to circulate your blood.

Angiotensin II receptor blockers (ARBs)

These medications have very similar benefits to ACE inhibitors as they work on the same pathway. If you can’t tolerate ACE inhibitors because of a reaction such as a cough or swelling, your doctor may prescribe ARBs instead. ACE inhibitors and ARBs are not used together.

Angiotensin receptor-neprilysin inhibitors (ARNis)

This type of combination medication pairs an ARB with a neprilysin inhibitor. In some people, this kind of combination treatment can be the most effective option.

An example of an ARNi is a treatment that combines valsartan (Diovan) and sacubitril (Entresto). It works to widen blood vessels while reducing excess fluid in your body.


Commonly known as water pills, diuretics help prevent excess fluid buildup in your body. You may have increased thirst and urination while using them.

Potential benefits include easier breathing and reduced bloating or swelling. These medications are given only for symptom relief — they do not help you live longer or change the course of the disease.

Aldosterone antagonists

This type of medication works on the stress hormone system that is activated in heart failure. It’s usually part of a combination of medications used to treat systolic heart failure.

These medications can cause high potassium levels. You may need to pay close attention to your diet so that you don’t consume too much potassium.


This medication, also called digitalis, slows your heart rate while increasing the strength of your heart muscle contractions. Your doctor may prescribe this medication if you have a heart rhythm issue such as atrial fibrillation.

This medication has been linked to some negative outcomes and toxicity, so it should be used carefully.


These are a class of intravenous (IV) medications usually given in a hospital setting. They help maintain blood pressure and improve the pumping action of your heart. These drugs are recommended for only short-term use.


Another important type of cardiac medication is vasodilators such as hydralazine and nitrates. These treatments help dilate (relax) blood vessels. When your blood vessels are relaxed, your blood pressure will lower. This helps your heart pump blood more easily.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors)

This drug class, often called SGLT-2 inhibitors, was originally approved for type 2 diabetes. But over time, people taking these medications also saw benefits for heart failure.

The drug class is now approved by the Food and Drug Administration (FDA) for treatment of heart failure. SGLT-2 inhibitors can improve blood sugar regulation, lower blood pressure, and contribute to weight loss.

What other medications may I be prescribed?

Your doctor may also prescribe a blood thinner to reduce your risk of clotting, especially if you have a heart rhythm issue such as atrial fibrillation.

Other kinds of treatment will likely address other conditions related to heart health, such as high blood pressure, diabetes, and high cholesterol. For example, your doctor may recommend statins to help lower your cholesterol levels.

Systolic heart failure is also known as heart failure with reduced ejection fraction. Ejection fraction measures how much of the blood that flows into your left ventricle is pumped out with each heartbeat.

Normal ejection fraction is between 55% and 70%. When you have systolic heart failure, your heart can’t pump as much blood out of the left ventricle as it should. Mild systolic dysfunction means a left ventricle ejection fraction of 41–49%. An ejection fraction measurement of less than 40% might be a sign of heart failure.

The other type of left ventricle heart failure is called diastolic heart failure, or heart failure with preserved ejection fraction. In this case, the left ventricle can pump properly but cannot relax normally between beats.

Unlike treatment for systolic heart failure, treatment for diastolic heart failure tends to focus on treating related conditions such as:

All the above conditions can contribute to heart failure. For this reason, it’s helpful to know your specific diagnosis. Your doctor can tell you whether you have left ventricle heart failure and whether it is systolic or diastolic.

When you have systolic heart failure, your body can’t circulate blood properly. Without medication, your body tries to compensate and restore this circulation. Your sympathetic nervous system activates and increases your cardiac output by making your heart beat faster and harder.

This compensation response isn’t meant to be continuously activated. This causes the receptors in your heart that activate your sympathetic nervous system to down-regulate. Your heart can’t keep up with the ongoing demand, and compensation changes to decompensation. Heart failure gets worse, and the cycle continues.

Medication slows down the progression of heart failure by interrupting the sympathetic nervous system response. It helps reduce the burden on your heart and plays a role in regulating cardiac output and stabilizing circulation.

Most medications have side effects. You can ask your doctor what to expect from the medication you’re taking.

Common side effects from heart failure medications include:

  • dizziness
  • nausea
  • headache
  • changes in appetite

Some side effects are harmless, while others require prompt medical attention. Your doctor can explain which side effects are a concern and when to seek treatment for them.

An effective treatment approach for heart failure involves taking more than one medication — usually a combination of medications.

For example, trials have shown that ACE inhibitors reduce the risk of dying from heart failure by 17%, but adding a beta-blocker medication improves that risk reduction to as much as 35%. Including the aldosterone antagonist spironolactone improves the outcome even more.

A combined medication therapy can lower the risk of dying from heart failure over the next 2 years by as much as 50%.

Your doctor will determine how many medications are right for you based on your specific heart failure and medical history.

To help your medications work well, take them as prescribed. Take the amount your doctor recommends at the proper times.

Pay attention to any additional instructions from your doctor or pharmacist. For example, take note of whether you can take your medication with food and whether certain foods, beverages, or vitamin supplements can interfere with how the medication works. Always ask your doctor before taking any supplements.

Write down all the medications you take and keep the list with you. If you have any questions, write those down, too, and make sure to ask your doctor.

Systolic heart failure, or heart failure with reduced ejection fraction, is treatable with medication. Without medication, heart failure tends to get worse.

The goal of treatment is to improve the quality of your life, reduce your risk of hospitalization, reduce your symptoms, and improve the function of your heart.

Always take your medication as prescribed. Your doctor can tell you more about how your medication works and why they recommend it for you.