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Angiotensin-Neprilysin Inhibition as a Paradigm for All?

  • Heart Failure (MR Mehra and E Joyce, Section Editors)
  • Published:
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Abstract

Composite angiotensin receptor-neprilysin inhibition (ARNi) represents a novel pharmacologic strategy for treatment of heart failure with reduced ejection fraction (HFrEF). In the PARADIGM-HF (Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial of 8399 subjects with HFrEF, treatment with the ARNi LCZ696 (sacubitril/valsartan) was associated with statistically important reductions in cardiovascular death, all-cause mortality, and the composite of cardiovascular death or heart failure hospitalization in comparison with enalapril. These data have supported the US and European regulatory approval of sacubitril/valsartan and guideline-based recommendations for its use in the treatment of selected patients with HFrEF. In this review, we discuss the evidence supporting use of ARNi in preference to angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers in patients with HFrEF and identify a strategy for selection of appropriate patients for transition to ARNi in clinical practice.

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Authors and Affiliations

  1. Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Muthiah Vaduganathan & Akshay S. Desai

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  1. Muthiah Vaduganathan
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  2. Akshay S. Desai
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Correspondence to Akshay S. Desai.

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Conflict of Interest

Muthiah Vaduganathan has no relevant conflicts of interest related to this work. Akshay S. Desai has been a paid consultant to Novartis, St. Jude Medical, Merck, Janssen, Sanofi, and Relypsa and has received research support from Novartis related to participation in the PARADIGM-HF and PARAGON-HF trials.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Heart Failure

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Vaduganathan, M., Desai, A.S. Angiotensin-Neprilysin Inhibition as a Paradigm for All?. Curr Cardiol Rep 18, 115 (2016). https://doi.org/10.1007/s11886-016-0784-z

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  • DOI: https://doi.org/10.1007/s11886-016-0784-z

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