Angiotensin receptor / neprilysin inhibitors (ARNIs) : the new hope in the management of heart failure
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 9
Abstract
Heart failure (HF) represents major challenges in cardiovascular disease and despite newer therapeutic advances, mortality still remains high. Inhibition of neurohumoural pathways such as the renin angiotensin aldosterone and sympathetic nervous systems is central in the management of heart failure. LCZ696 (sacubutril/valsartan), a first-in-class angiotensin II AT1 receptor neprilysin inhibitor (ARNI), has a unique mode of action that targets both pathways. The Prospective comparison of ARNI with angiotensin convertase enzyme inhibitor (ACEI) to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF) trial demonstrated that morbidity and mortality can be improved with the ARNI. This trial suggests that sacubitril/valsartan should replace an ACE inhibitor or angiotensin receptor blocker for the treatment of symptomatic patients (NYHA II–IV) with HF with reduced ejection fraction. This review will explore the background of neprilysin inhibition in management of HF, the results of the PARADIGM-HF trial and also guide how to use sacubitril/valsartan in clinical practice.
Authors and Affiliations
Soumya Patra, Rabin Chakraborty
Keywords
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