sGC stimulators

Soluble Guanylate Cyclase (also termed Guanylyl Cyclase) stimulators (sGCS) and activators reduce oxidative stress by increasing levels of nitric oxide in the heart and blood vessels. These drugs are novel and their use in heart failure is limited. One such sGCS agent is riociguat which is approved for the treatment of specific condition called pulmonary hypertension, which affects blood vessels in the lungs. Another sGCS agent, vericiguat, when added to standard medications, may help to prevent hospitalization in with severe heart failure.

What they do: Approximately a quarter of heart failure patients have low levels of cyclic guanosine monophosphate (cGMP). The cGMP molecule is a key intracellular messenger, which protects heart, vessels and kidneys. One of the main actions of cGMP is a relaxation of blood vessels and cardiac cells. Soluble Guanylate Cyclase stimulators (sGCS) increase the formation of cGMP, therefore, reduce the stiffness of cardiac cells and vessels.

What are the expected benefits? In patients hospitalized for heart failure who have left ventricular ejection fraction lower than 45%, vericiguat may reduce heart failure-related re-hospitalizations and prolong life.

Side effects: Vericiguat is well tolerated as compared to placebo. Symptomatic hypotension (too low blood pressure) and anemia were reported in a small number of patients.

Top tips: Vericiguat is taken as an oral tablet once daily. As with other medicines for heart failure, the dose is increased slowly in several steps.


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ESC Guidelines for Heart Failure

What patients need to know

This guide for patients from the European Society of Cardiology aims to provide an overview of the latest evidence-based recommendations for the diagnosis and treatment of heart failure.

In particular, it should help patients to understand the:

  • main types of heart failure
  • medicines used to treat heart failure
  • devices that may be appropriate
  • importance of rehabilitation
  • management by a multidisciplinary team
  • importance of self-care in managing your own condition

Learn more


A series of 9 simple, captivating animations explaining heart failure and its treatment.

These narrated animations explain how a healthy heart works, what happens to it in heart failure and how various treatments work to improve your health.


In this section you can watch, listen or read interviews with other people with heart failure and their caregivers.


and share your own views and experiences with other patients, families and caregivers. is a European Society of Cardiology website

The website was developed under the direction of the Heart Failure Association of the European Society of Cardiology (ESC). The ESC is a world leader in the discovery and dissemination of best practices in cardiovascular medicine. Our members and decision-makers are healthcare professionals who volunteer their time and expertise to represent professionals in the field of cardiology in Europe and beyond.

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