Related Experiment Video

Updated: Jul 12, 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

3.3K

Angiotensin-Neprilysin inhibition in heart failure with preserved ejection fraction: A meta-analysis of randomized

Jishanth Mattumpuram1, Muhammad Talha Maniya2, Craig Albert Luke Fernandes3

  • 1Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.

Current Problems in Cardiology
|October 23, 2023
PubMed

Insights

Sacubitril/valsartan therapy in heart failure with preserved ejection fraction (HFpEF) reduced NT-proBNP levels and improved quality of life. While not reaching statistical significance, trends suggested potential benefits in major HF outcomes and renal function protection.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Heart failure with preserved ejection fraction (HFpEF) remains a significant clinical challenge with ongoing debates regarding optimal treatment strategies.
  • The efficacy of sacubitril/valsartan, a neprilysin inhibitor and angiotensin receptor blocker combination, in HFpEF is an area of active investigation.

Purpose of the Study:

  • To systematically evaluate the effects of sacubitril/valsartan on clinical outcomes and biomarkers in patients with HFpEF.
  • To synthesize evidence from randomized controlled trials to inform treatment guidelines and clinical decision-making for HFpEF management.

Main Methods:

  • A comprehensive literature search of Medline was conducted from inception through May 2023 to identify relevant randomized controlled trials.
  • Meta-analysis techniques, including pooling of geometric mean ratios (gMR) and weighted mean differences (WMD) for continuous outcomes, and risk ratios (RR) for dichotomous outcomes, were employed with 95% confidence intervals (CI).

Main Results:

  • Four trials involving 8,129 patients were analyzed. Sacubitril/valsartan significantly reduced NT-proBNP levels (gMR: 0.84) and improved Kansas City Cardiomyopathy Questionnaire (KCCQ) scores (WMD: 0.85).
  • No statistically significant differences were observed in HF hospitalizations, cardiovascular mortality, or all-cause mortality. A trend towards improvement in NYHA class was noted.
  • Patients receiving sacubitril/valsartan showed a reduced risk of a ≥50% decline in estimated glomerular filtration rate (eGFR) (RR: 0.60), indicating a potential renal protective effect.

Conclusions:

  • Pooled data indicate that sacubitril/valsartan effectively lowers natriuretic peptide levels and enhances quality of life in patients with HFpEF.
  • While major clinical endpoints did not reach statistical significance, a numerical trend towards improved HF outcomes and evidence of renal protection suggest potential benefits of sacubitril/valsartan therapy in this population.
Abstract

Keywords:
ARNIsAngiotensin receptor-neprilysin inhibitorHFpEFHeart failureSacubtril/Valsartan

More Related Videos

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs07:09

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs

Published on: February 18, 2022

1.9K
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

4.8K

Related Concept Videos

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...
438
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...
9
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
14
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...
674
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
346
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,...
650