Beta-blockers, ACE inhibitors and diuretics.

The most effective drug treatment for heart failure caused by coronary heart disease and heart attack is a triple combination of: an ACE inhibitor, a beta-blocker and a diuretic ('water tablet'). Diuretics are usually the first to be prescribed followed by ACE inhibitors and beta-blockers. Getting the balance of these three drugs right for each individual is complicated and may take time. As heart failure progresses the drugs may need to be taken in stronger doses. Several people we talked to had noticed considerable improvements in their condition since taking the triple combination of drugs.

Says that the triple combination of drugs has made him feel much better.

Diuretics help the kidneys to pass more salt and water into the urine, which reduces ankle swelling, lowers blood pressure and should relieve breathlessness. Everyone we talked to was taking a diuretic which they said was extremely effective at reducing excess fluid and helping relieve breathlessness. Most people accepted that they would need to go to the loo much more than before and that they needed to plan their lives accordingly; one woman found she was going to the loo at least 6 times between breakfast and lunch, others had been advised to take their diuretic earlier in the day to avoid being kept awake at night. Several people resented the effect diuretics had on their lives, particularly when they wanted to travel long distance by coach, attend meetings or go to church, and so sometimes did not take them exactly as prescribed (see 'Coping with medication'). Taking diuretics for long periods was linked with dehydration (see 'Side effects of medication').

Explains how she copes with needing to go to the loo and taking diuretics.

Took advice from her pharmacist about when to take diuretics.

Beta-blockers work by making the heart beat more slowly, and were thought of by many as the most important drug for heart failure; one man described beta-blockers as 'the big stuff' and another thought that his doctors and heart failure nurse were only really interested in his beta-blockers. Some people said they had experienced dizziness, nausea and diarrhoea when they first started the beta-blocker, and one woman said that at first they made her feel more ill but that she knew she had to persevere with them nonetheless. Many people were comfortable with beta-blockers once the right level had been reached. Several men said that they had experienced loss of libido since taking beta-blockers and ACE inhibitors but were uncertain which had caused it. (See 'Side effects of medication').

Says that his doctors take most interest in his beta-blockers.

Felt ill at first with her beta-blocker but has persevered with them.

ACE (Angiotensin converting enzyme) inhibitors are prescribed for those who have developed heart failure from coronary heart disease. They work by relaxing the arteries enabling blood to flow through them more freely. The triple combination of drugs makes it difficult for people to know which drugs are associated with which side effects (see 'Side effects of medication').

For a description of specific drugs see Heart Failure Matters.