From ARB to ARNI in Cardiovascular Control

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Hypertension, diabetes, and chronic kidney disease (CKD) increase cardiovascular and renal risks.
• Current antihypertensive treatments offer limited benefits to these multi-morbid patients.
• Angiotensin II type 1 receptor blockade and neprilysin inhibition (ARNI) may enhance beneficial effects by modulating the natriuretic peptide system.

Purpose of the Study:

• To review the effects of ARNI (valsartan/sacubitril) in animal models and human populations with cardiovascular and renal comorbidities.
• To explore the potential mechanisms and side effects of ARNI in high-risk patient groups.

Main Methods:

• Review of studies involving ARNI in animal models of hypertension, myocardial infarction, and diabetes.
• Analysis of clinical trial data on ARNI's effects in hypertensive, heart failure, and diabetic patients.
• Discussion of potential mechanisms, including natriuretic peptide system interaction and renal hemodynamics.

Main Results:

• In animals, ARNI reduced cardiac weight and fibrosis, proteinuria, glomerulosclerosis, and retinopathy independently of blood pressure.
• In humans, ARNI lowered blood pressure, reduced cardiovascular mortality in heart failure, and decreased albuminuria in diabetic patients.
• Potential mechanisms involve improved renal hemodynamics and natriuretic peptide levels, though further research is needed.

Conclusions:

• ARNI demonstrates potential benefits for patients with coexisting hypertension, diabetes, and CKD.
• Reduced cardiovascular and renal morbidity/mortality is observed, particularly in diabetic patients.
• Potential side effects include hypotension in CKD patients due to renal clearance of sacubitrilat; caution is advised.