What medications can treat hypertrophic cardiomyopathy?

Hypertrophic cardiomyopathy (HCM) is a genetic heart condition that causes thickening of the heart muscle—more specifically, the left ventricle. The left ventricle is the lower left chamber of the heart. This is the part of the heart that pumps oxygenated blood out of the heart so it can be distributed throughout the body.

Most people with HCM have what is called obstructive hypertrophic cardiomyopathy, where the thickened cardiac muscle impairs the left ventricle’s ability to fully empty of blood when it pumps. This can lead to problems including chest pain, shortness of breath, fainting, and abnormal heart rhythms. It can also lead to complications including blood clots, stroke, and sudden cardiac arrest.

Others have nonobstructive hypertrophic cardiomyopathy, which does not impair the heart’s ability to pump blood. However, regardless of what type of HCM a person has, anyone with HCM is at risk for complications and should be working with a cardiologist.

What is the treatment for HCM?

Treatment for HCM aims to alleviate symptoms, prevent complications, and improve overall heart function. Because the condition affects different people in different ways, treatment plans are individualized. Maintaining a healthy weight, remaining hydrated, and other lifestyle modifications are an essential part of a treatment plan. Medications are also a part of treatment for many people with HCM.

What medications treat hypertrophic cardiomyopathy?

Medications may be prescribed to manage symptoms and improve heart function. Medications commonly used in the treatment of HCM include:

• Beta-blockers. These medications help reduce heart rate and blood pressure, relieving symptoms such as chest pain, shortness of breath, and palpitations. Beta-blockers also help improve the heart's filling capacity and relaxation.
• Calcium channel blockers. These medications relax blood vessels, reduce the workload on the heart, and improve blood flow.
• Anti-arrhythmic drugs. In individuals with HCM who experience irregular heart rhythms, anti-arrhythmic medications may be prescribed to help restore normal heart rhythm.
• Diuretics. Also called water pills, these drugs help the body remove excess amounts of fluid and sodium. These drugs can help reduce how hard the heart needs to work.
• Anticoagulants. Also known as blood thinners, anticoagulant medications can help prevent blood clots and strokes in people who have a type of arrhythmia called atrial fibrillation or a type of HCM called apical hypertrophic cardiomyopathy.
• Cardiac myosin inhibitors. These are medications that help the heart contract with less force and reduce the abnormal thickening of the heart muscle. The first of these medications for HCM was approved in 2022, and others are under development.

What is the best treatment for hypertrophic cardiomyopathy?

The choice of medication and dosage depends on a person’s specific symptoms, overall health, and how they respond to treatment. Regular follow-ups with a healthcare provider are essential to monitor the effectiveness and adjust the medication dosage if needed. In addition to lifestyle modifications and medications, HCM may also be treated with surgical and nonsurgical procedures to reduce thickened cardiac muscle.

Early treatment and adherence to treatment can help reduce the risk of complications and keep the heart as healthy as possible. There is no best treatment for HCM, only the treatment that is best for a particular person at a particular time. A treatment plan can change over time and as new therapies become available.