Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, may be an effective and safe therapy for reducing risk of cardiovascular death or heart failure hospitalization and improving quality of life in patients with heart failure with reduced ejection fraction (HFrEF) compared to enalapril, according to a state-of-the-art review published Sept. 28 in JACC: Heart Failure.

In the five years since the PARADIGM-HF trial was released, a series of subsequent analyses have provided further insight into the benefits of sacubitril/valsartan compared to enalapril.

Kieran F. Docherty, MBCHB, et al., review how neprilysin inhibition works; the clinical benefits of sacubitril/valsartan versus renin-angiotensin aldosterone system blockade alone; the safety of sacubitril/valsartan; sacubitril/valsartan across the HF spectrum; and practical considerations with sacubitril/valsartan. The authors also provide a practical and evidence-based approach to the clinical integration of sacubitril/valsartan in patients with HFrEF.

"In the last [five] years, sacubitril/valsartan has been established as a cornerstone component of comprehensive disease-modifying medical therapy in the management of chronic HFrEF," write the authors. "The next [five] years should see its wider implementation in practice and potential expansion of its therapeutic indications."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Enalapril, Heart Failure, Renin-Angiotensin System, Neprilysin, Stroke Volume, Quality of Life, Aminobutyrates, Tetrazoles, Ventricular Dysfunction, Left, Hospitalization, Angiotensins

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