Angiotension-converting enzyme (ACE) inhibitors - reduces AII formation by inhibiting conversion of AI to AII; arteriolar and venous dilation, ↓aldosterone secretion, ↓ cardiac remodeling, ↑ CO

Cough, hyperkalemia, Angioneurotic edema

Fetal abnormalities

Altered taste

Dry cough

Chronic heart failure, hypertension, diabetic renal disease

Angiotension (AT₁) receptor blockers (ARBs); similar effect as ACE inhibitors

Hyperkalemia, angioneurotic edema

Fetal abnormalities

Used in patients intolerant to ACE inhibitors

Na⁺,K⁺ ATPase inhibition results in reduced Ca⁺² expulsion and ↑ Ca⁺² stored in sarcoplasmic reticulum leading to ↑ contractility; parasympathomimetic effects (e.g. sensitation of baroreceptors, central vagal stimulation, facilitation of muscarinic transmission)

Nausea, vomiting, diarrhea, cardiac arrhythmias

altered color vision 

Chronic toxicity:  a calcium overload, which can lead to arrhythmia and tachycardia.

Acute toxicity: hyperkalemia and cardiac arrest.

Heart failure, rapid ventricular rate in atrial fibrillation

β₁-selective agonist, increases cAMP synthesis; increases cardiac contractility, output, with a decrease in ventricular filling pressure

Arrhythmias and angina in patients with coronary artery disease; tachyphylaxis

Acute decompensated heart failure, intermittent therapy in chronic failure reduces symptoms

Phosphodiesterase type 3 inhibition decreases cAMP breakdown and causes vasodilation and ↑ contractility

Nausea, vomiting, arrhythmias, thrombocytopenia, liver enzyme changes

Acute decompensated heart failure

Under normal conditions, endothelin causes pulmonary vasoconstriction. By blocking this interaction, bosentan ↓ pulmonary vascular resistance.

Hepatotoxicity, anemia, teratogenic, interacts with hormone-based contraception in women

Pulmonary artery hypertension

Synthetic form of brain natriuretic peptide (BNP) that activates BNP receptors; increases cGMP in smooth muscle cells causing vasodilation; also causes diuresis

Excessive hypotension, renal damage

Acute (not chronic) heart failure

given IV