Evidence-Based Medical Therapy for Mitral Regurgitation in Dogs

Myxomatous mitral valve disease (MMVD) is the most common acquired cardiac disease in dogs and a leading cause of congestive heart failure. Over the past three decades, clinical trials and translational studies have generated a substantial evidence base supporting specific medical therapies, particularly drugs that modulate hemodynamics or target the renin–angiotensin–aldosterone system (RAAS). At the same time, gaps remain in our knowledge, and areas of clinical practice are guided more by expert consensus or extrapolation from human medicine than by robust veterinary data. This review summarizes current evidence for pharmacologic interventions in MMVD, including established therapies such as ACE inhibitors, mineralocorticoid receptor antagonists, diuretics, and inodilators, as well as emerging drug classes such as angiotensin receptor–neprilysin inhibitors and SGLT-2 inhibitors. For each, we highlight the existing data, discuss limitations of prior studies, and note areas where additional research is needed to guide optimal clinical use.