Key result
In-hospital sacubitril/valsartan lowers NT-proBNP ~29% more than enalapril in Black patients with ADHF.
Why the study?
Black patients show different treatment responses to ACE inhibitors than other racial groups, but their response to sacubitril/valsartan during acute decompensated heart failure remained unclear.
Does sacubitril/valsartan reduce NT-proBNP levels and improve clinical outcomes compared to enalapril in Black and non-Black Americans hospitalized with acute decompensated heart failure?
RCT (n=881)
Double-blind
randomized
Does sacubitril/valsartan reduce NT-proBNP levels and improve clinical outcomes compared to enalapril in Black and non-Black Americans hospitalized with acute decompensated heart failure?
In-hospital initiation of sacubitril/valsartan is more effective than enalapril in reducing NT-proBNP and clinical events in patients with acute decompensated heart failure, with consistent benefits observed regardless of race.
Supports in-hospital sacubitril/valsartan initiation over enalapril in Black ADHF patients; extends ARNI evidence with consistent effects across races.
This study compared the efficacy and safety of sacubitril/valsartan to enalapril in Black and non-Black Americans with acute decompensated heart failure (ADHF). Black patients have a different response to treatment with angiotensin-converting enzyme inhibitors compared with other racial and ethnic groups. How Black patients with ADHF respond to sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor, is unclear. PIONEER-HF was a double-blind randomized clinical trial of sacubitril/valsartan versus enalapril in hospitalized patients with ADHF following hemodynamic stabilization. In a pre-specified subgroup analysis, we examined changes in N-terminal pro–B-type natriuretic peptide, clinical outcomes, and safety according to race. The study population, all enrolled in the United States, included 316 (36%) Black participants, 515 (58%) White participants, and 50 (5.7%) participants of other racial groups. The reduction in N-terminal pro–B-type natriuretic peptide concentration at weeks 4 and 8 was significantly greater with sacubitril/valsartan than enalapril in both Black (ratio of change with sacubitril/valsartan vs. enalapril: 0.71; 95% confidence interval [CI]: 0.58 to 0.88) and non-Black patients (ratio of change: 0.71; 95% CI: 0.61 to 0.83; interaction p = 1.00). Compared with enalapril, sacubitril/valsartan also reduced the pre-specified exploratory composite of cardiovascular death or HF rehospitalization in both Black (hazard ratio: 0.47; 95% CI: 0.24 to 0.93) and non-Black patients (hazard ratio: 0.65; 95% CI: 0.40 to 1.06; interaction p = 0.44). Among Black patients admitted with ADHF in the United States, the in-hospital initiation of sacubitril/valsartan was more effective than enalapril in reducing natriuretic peptide levels and the composite of cardiovascular death or HF rehospitalization. The effect of sacubitril/valsartan did not differ by race. (Comparison of Sacubitril/Valsartan Versus Enalapril on Effect on NT-proBNP in Patients Stabilized From an Acute Heart Failure Episode [PIONEER-HF]; NCT02554890)
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Berardi et al. (2020) conducted an RCT in Acute decompensated heart failure (ADHF) (n=881). Sacubitril/valsartan vs. Enalapril was evaluated on Reduction in N-terminal pro-B-type natriuretic peptide concentration at weeks 4 and 8 in Black patients (ratio of change 0.71, 95% CI 0.58 to 0.88). In-hospital initiation of sacubitril/valsartan was more effective than enalapril in reducing NT-proBNP levels in Black patients with ADHF (ratio of change 0.71; 95% CI 0.58-0.88).
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