Related Experiment Video

Updated: Dec 9, 2025

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

3.8K

Angiotensin-Neprilysin Inhibition in Black Americans: Data From the PIONEER-HF Trial

Cecilia Berardi1, Eugene Braunwald2, David A Morrow2

  • 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

JACC. Heart Failure
|September 13, 2020
PubMed

Insights

Sacubitril/valsartan demonstrated superior efficacy over enalapril in reducing natriuretic peptide levels and cardiovascular events for Black and non-Black patients with acute decompensated heart failure. The treatment benefits were consistent across racial groups in this study.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Black patients exhibit distinct responses to angiotensin-converting enzyme inhibitors.
  • The efficacy of sacubitril/valsartan in Black patients with acute decompensated heart failure (ADHF) remains under investigation.
  • PIONEER-HF was a randomized trial comparing sacubitril/valsartan and enalapril in hospitalized ADHF patients.

Purpose of the Study:

  • To compare the efficacy and safety of sacubitril/valsartan versus enalapril in Black and non-Black Americans with ADHF.
  • To evaluate the impact of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide levels and clinical outcomes across racial groups.
  • To assess the safety profile of sacubitril/valsartan compared to enalapril in diverse patient populations.

Main Methods:

  • A pre-specified subgroup analysis of the PIONEER-HF trial was conducted.
  • Changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured at 4 and 8 weeks.
  • Clinical outcomes, including cardiovascular death or heart failure rehospitalization, were assessed.
  • Safety data were collected and analyzed according to race.

Main Results:

  • Sacubitril/valsartan significantly reduced NT-proBNP levels more than enalapril in both Black and non-Black patients (ratio of change: 0.71 for both).
  • The reduction in NT-proBNP by sacubitril/valsartan compared to enalapril showed no significant interaction with race (p=1.00).
  • Sacubitril/valsartan reduced the composite of cardiovascular death or HF rehospitalization in both Black (HR: 0.47) and non-Black patients (HR: 0.65), with no significant interaction by race (p=0.44).

Conclusions:

  • In-hospital initiation of sacubitril/valsartan was more effective than enalapril in Black patients with ADHF.
  • Sacubitril/valsartan effectively reduced natriuretic peptide levels and major adverse cardiovascular events in Black patients.
  • The therapeutic effects of sacubitril/valsartan in ADHF patients did not differ significantly by race.
Abstract

Keywords:
angiotensin receptor-neprilysin inhibitorenalaprilheart failurerace/ethnicitysacubitril/valsartan

More Related Videos

Author Spotlight: Network Pharmacology and Molecular Docking to Decipher the Action of Jiawei Shengjiang San Against Diabetic Kidney Disease08:15

Author Spotlight: Network Pharmacology and Molecular Docking to Decipher the Action of Jiawei Shengjiang San Against Diabetic Kidney Disease

Published on: May 10, 2024

826
A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis08:21

A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis

Published on: October 26, 2020

5.4K

Related Concept Videos

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
2.1K
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
737
Antihypertensive Drugs: Direct Renin Inhibitors01:25

Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
1.1K
Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
2.2K
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
125
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists01:18

Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists

Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
313