Key result
Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, demonstrated superiority over enalapril in reducing cardiovascular mortality and heart failure hospitalizations in patients with HFrEF.
Why the study?
Promising results with angiotensin receptor-neprilysin inhibitors raised the question of whether angiotensin converting enzyme inhibitors should remain first-line treatment for HFrEF.
Do ACE inhibitors and ARNIs reduce mortality and heart failure hospitalizations in patients with chronic HFrEF?
Do ACE inhibitors and ARNIs reduce mortality and heart failure hospitalizations in patients with chronic HFrEF?
This review highlights that ARNI therapy (sacubitril/valsartan) demonstrates superior efficacy compared to traditional ACEi therapy (enalapril) in reducing mortality and hospitalizations in patients with HFrEF.
Supports ARNI preference in HFrEF; leaves open questions on real-world implementation and subgroups.
Heart failure (HF) is a multi-faceted clinical condition affecting up to 2% of the population in the developed world and is linked to significant morbidity and mortality, therefore posing a major public health concern. To this date, pharmacotherapy for HF has mainly focused on chronic HF with reduced ejection fraction (HFrEF), with angiotensin converting enzyme inhibitors (ACEi) being at the centre of the management plan, alongside angiotensin-receptor-blockers (ARBs), β-blockers (BB) and mineralocorticoid receptor antagonists (MRAs). A novel and recently approved therapy, however, involving angiotensin receptor-neprilysin inhibitors (ARNI), has shown very promising results and comparable to those of ACEi, which raises the question of whether ACEi should remain the first-line treatment option for HFrEF. In this review, the evidence regarding the clinical efficacy of ACEi and ARNI in the treatment of HFrEF is discussed, with emphasis placed on the major landmark trials.
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Sosipatros Bratsos (2019) conducted a review in Chronic Heart Failure with reduced ejection fraction (HFrEF). Angiotensin Receptor-Neprilysin Inhibitors (sacubitril/valsartan) vs. Angiotensin Converting Enzyme inhibitors (enalapril) or placebo was evaluated. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, demonstrated superiority over enalapril in reducing cardiovascular mortality and heart failure hospitalizations in patients with HFrEF.
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