Similarities and Differences in Agents Used for the Treatment of Diastolic and Systolic Heart Failure
| Similarities | Differences | |
|---|---|---|
| β-Blockers | • Used to treat HTN | • Used to modify left ventricular remodeling to prolong survival in SHF |
| • May be used to rate control patients with atrial fibrillation or flutter | • Titrated slowly to specific dose in SHF | |
| • In DHF, used to decrease heart rate and prolong diastole to reduce symptoms | ||
| • DHF titrated more rapidly to response than in SHF | ||
| Calcium channel blockers | • May be used to treat HTN | • Generally avoided in treating SHF |
| • Shown to improve diastolic parameters and exercise tolerance | ||
| • Particularly useful in setting of atrial fibrillation | ||
| Diuretics | • Symptom reduction through volume reduction in acute and chronic settings | • Patients with SHF more likely to require higher doses and long-term therapy |
| • May be used to treat HTN | • Patients with DHF more likely to tolerate weaning | |
| • Judicious use in DHF as patients may be preload-dependent | ||
| Nitrates | • Used to treat patients with ischemic heart disease | |
| • Contribute to volume reduction | ||
| ACEIs | • May be used to treat HTN | • Ample data to support use in SHF although relatively few studies in patients with DHF |
| • Associated with LV regression and experimental data suggest improved myocardial relaxation | ||
| ARBs | • May be used to treat hypertension | • Few trials in patients with DHF |
| • Associated with LV regression and experimental data suggest improved myocardial relaxation | ||
| Spironolactone | • Aldosterone, which promotes fluid retention, myocardial, and vascular fibrosis is blocked. May have benefit in both DHF and SHF treatment | • Shown to improve symptoms, decrease risk of death, and hospitalization in SHF |
| Digoxin* | • Beneficial for rate control in patients with atrial fibrillation or flutter | • Used to improve ejection fraction in patients with SHF |
| • May increase intracellular calcium concentration, which may impair diastolic relaxation |
* Digoxin use is controversial in the treatment of DHF.
β-blocker, β-adrenergic receptor blocker; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; HTN, hypertension; SHF, systolic heart failure; DHF, diastolic heart failure; LV, left ventricle.