Key result
ARNI outperforms ACEi alone in HFrEF.
Why the study?
Recent evidence demonstrating the superior efficacy of neprilysin inhibition added to angiotensin receptor blockade over ACE inhibition alone in HFrEF prompted a review of major trials shaping renin-angiotensin-aldosterone and neprilysin pathway inhibition.
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?
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?
The transition from ACE inhibitors/ARBs to ARNIs represents a significant milestone in the pharmacological management of heart failure with reduced ejection fraction.
Supports ARNI over ACEI in HFrEF; leaves open CAD-specific validation.
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.
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Leong et al. (2019) conducted a review in Heart failure with reduced ejection fraction and coronary artery disease. Neprilysin inhibition added to angiotensin receptor blockade (ARNIs) vs. Angiotensin-converting enzyme (ACE) inhibition alone was evaluated. 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.
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