Angiotensin receptor-neprilysin inhibitors: A new paradigm in heart failure with reduced ejection fraction.

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. [ABSTRACT FROM AUTHOR]