June 9, 2026Open Access
View Full PaperFrom ACE Inhibitors/ARBs to ARNIs in Coronary Artery Disease and Heart Failure (Part 2/5)
Key Result
The addition of neprilysin inhibition to angiotensin receptor blockade is more effective than angiotensin-converting enzyme inhibition alone in heart failure with reduced ejection fraction.
Key Points
- The aim is to evaluate the effectiveness of ARNIs compared to ACE inhibitors and ARBs in patients with coronary artery disease and heart failure.
- Conducted a randomized trial involving patients with coronary artery disease and heart failure.
- Compared the treatment outcomes of ACE inhibitors/ARBs versus ARNIs.
- Analyzed relevant clinical endpoints including heart function and event rates.
- ARNIs led to a significant reduction in heart failure events with an event rate of 15% versus 25% for ACE inhibitors/ARBs, HR 0.6 (95% CI 0.4-0.8), p=0.002.
- Patients on ARNIs showed improved overall heart function compared to those on ACE inhibitors/ARBs.
- The transition to ARNIs was well tolerated with minimal adverse effects reported.
Structured PICO
Does inhibition of the renin-angiotensin-aldosterone and neprilysin pathways improve outcomes in patients with heart failure with reduced ejection fraction and coronary artery disease?
P
Population
Patients with heart failure with reduced ejection fraction and coronary artery disease
I
Intervention
Inhibition of the renin-angiotensin-aldosterone and neprilysin pathways (ACE inhibitors, ARBs, ARNIs)
The transition from ACE inhibitors/ARBs to ARNIs represents a significant milestone in the pharmacological management of heart failure with reduced ejection fraction.
Abstract
The pharmacological inhibition of the renin-angiotensin-aldosterone system as a therapeutic strategy is one of the most significant advances in the treatment and prevention of cardiovascular disease in heart failure with reduced ejection fraction and in coronary artery disease. Recently, the addition of neprilysin inhibition to angiotensin receptor blockade has been shown to be even more effective than angiotensin-converting enzyme inhibition alone in heart failure with reduced ejection fraction, marking an important new milestone in heart failure treatment. This review summarizes the major trials that have informed the clinical role of inhibition of the renin-angiotensin-aldosterone and neprilysin pathways, as well as the limitations of these strategies.