Angiotensin receptor-neprilysin inhibitors: A new paradigm in heart failure with reduced ejection fraction. (15th April 2019)

• Record Type: Journal Article
• Authors: Docherty, Kieran F.; McMurray, John J.V.
• Is Part Of: International journal of cardiology. Volume 281(2019)
• Page Start: 179
• Page End: 185
• Publication Date: 2019-04-15
• Subjects: Heart failure -- Heart failure with reduced ejection fraction -- Renin-angiotensin aldosterone system -- Natriuretic peptides -- Neprilysin -- Angiotensin receptor-neprilysin inhibitor; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.05.124
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Despite significant advances in the last 30 years in reducing morbidity and mortality from heart failure with reduced ejection fraction (HFrEF) with pharmacological and device-based therapies, patients remain at a high risk of adverse cardiovascular outcomes. Sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin inhibitors (ARNI), has been shown to reduce the risk of cardiovascular death or heart failure hospitalisation and improve symptoms in patients with chronic, ambulatory, symptomatic HFrEF in a large, phase 3, multicentre, international, randomised controlled trial, PARADIGM-HF, when compared to the gold-standard angiotensin converting enzyme inhibitor, enalapril. This article will review the development of sacubitril/valsartan, the evidence for its use and its current and future role in the management of HFrEF. Highlights: Natriuretic peptides have protective properties in heart failure with reduced ejection fraction. Neprilysin degrades natriuretic peptides as well as other vasoactive peptides. Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor. Sacubitril/valsartan reduces mortality, the risk of heart failure hospitalisation and symptoms in patients with heart failure compared with the ACE-inhibitor, enalapril.