The Efficacy and Safety of Sacubitril/Valsartan in Heart Failure Patients: A Review

Zhang, Rui; Sun, Xiaotong; Li, Ya; He, Wenzheng; Zhu, Hongguang; Liu, Baoshan; Zhang, Aiyuan

doi:10.1177/10742484211058681

Cited by 11 publications

(23 citation statements)

References 72 publications

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“…Renin–angiotensin–aldosterone system (RAAS) inhibitors should also be considered because of their effects on serum potassium and fluctuations in serum creatinine levels caused by hemodynamic changes, such as reduced eGFR ( 18 ). However, there is almost no evidence that RAAS inhibition improves the prognosis of patients with CKD exhibiting heart failure with preserved ejection fraction (HFpEF) ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

Gan

Lyu²,

Yang³

et al. 2022

Front. Med.

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Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease, including coronary heart disease, heart failure, arrhythmia, and sudden cardiac death. Therefore, developing effective methods to control risk factors and improve prognosis is the primary focus during the diagnosis and treatment of CKD. For example, the SPRINT study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. A co-crystal complex of sacubitril, which is a neprilysin inhibitor, and valsartan, which is an angiotensin receptor blockade, has the potential to be widely used against CKD. Sacubitril inhibits neprilysin, which further reduces the degradation of natriuretic peptides and enhances the beneficial effects of the natriuretic peptide system. In contrast, valsartan alone can block the angiotensin II-1 (AT1) receptor and therefore inhibit the renin–angiotensin–aldosterone system. These two components can act synergistically to relax blood vessels, prevent and reverse cardiovascular remodeling, and promote natriuresis. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin–angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, we propose clinical recommendations based on an expert consensus to guide ARNI-based therapeutics and reduce the occurrence of cardiovascular events in patients with CKD.

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Section: Introductionmentioning

confidence: 99%

Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

Gan

Lyu²,

Yang³

et al. 2022

Front. Med.

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“…Globally, heart failure (HF) is one of the significant causes of morbidity and mortality, and it is considered a complex clinical syndrome attributed to any anatomic or physiologic impairment of the ejection of blood or ventricular filling [1,2]. In the United States (US), the statistic shows that more than 5.1 million individuals presented with clinical manifestations of HF and 650,000 new cases per year [1]. Additionally, HF generates an enormous financial burden worldwide with high mortality and hospitalization rates [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…In the United States (US), the statistic shows that more than 5.1 million individuals presented with clinical manifestations of HF and 650,000 new cases per year [1]. Additionally, HF generates an enormous financial burden worldwide with high mortality and hospitalization rates [1,2]. HF is classified according to the left ventricular ejection fraction (LVEF) as HF with reduced EF (HFrEF; with an ejection fraction (EF) <40%), with mildly reduced EF (HFmrEF; EF 41%-49%), and HF with preserved EF (HFpEF; EF ≥50%) [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, HF generates an enormous financial burden worldwide with high mortality and hospitalization rates [1,2]. HF is classified according to the left ventricular ejection fraction (LVEF) as HF with reduced EF (HFrEF; with an ejection fraction (EF) <40%), with mildly reduced EF (HFmrEF; EF 41%-49%), and HF with preserved EF (HFpEF; EF ≥50%) [1,2]. Furthermore, HF can be classified according to exercise tolerance as New York Heart Association (NYHA) I to IV [2].…”

Section: Introductionmentioning

confidence: 99%

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Heart Failure Management, including Recently Approved Therapeutic Options: An Overview

López¹

2022

JOCCT

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Heart failure (HF) affects the heart's structure and function. It is considered a complex clinical syndrome attributed to any anatomic or physiologic impairment of the ejection of blood or ventricular filling. The incidence of this clinical condition is increasing and causing a significant impact on healthcare systems worldwide. Since the pathophysiology of HF is well understood, treatment options have had significant advancements. Initially, many compensatory mechanisms are helpful, but over time they contribute to the progression of the disease, such as increased adrenergic activity, renin-angiotensin-aldosterone system activity, and secretion of B-type natriuretic peptide (BNP). These may cause progressive myocardial damage. For this reason, different groups of drugs are used for managing HF, targeting different points of the physiopathology of HF. An instance is the drug combination sacubitril/valsartan, which increases BNP levels while simultaneously inhibiting the renin-angiotensin system (RAS). Other examples include sodium-glucose cotransporter 2 inhibitors (SGLT2i), which lower blood pressure, soluble guanylate cyclase (sGC) stimulators that cause smooth muscle relaxation and vasodilation, beta-blockers (BBs), which lower heart rate and contractility, and mineralocorticoid receptor antagonists (MRAs), which maintain water and electrolyte homeostasis. This article is aimed to identify when these medications are recommended, and to point out the recently FDA-approved SGLT2i and soluble guanylyl cyclase (sGC) stimulator (vericiguat), taking into account their adverse effects, symptoms, and comorbidities of the patient that may worsen the disease process.

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“…Renin-angiotensinaldosterone system (RAAS) inhibitors should also be considered because of their effects on serum potassium and fluctuations in serum creatinine levels caused by hemodynamic changes, such as reduced eGFR (18). However, there is almost no evidence that RAAS inhibition improves the prognosis of patients with CKD exhibiting heart failure with preserved ejection fraction (HFpEF) (20).…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy and Safety of Sacubitril/Valsartan in Heart Failure Patients: A Review

Cited by 11 publications

References 72 publications

Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

Application of Angiotensin Receptor–Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus

Heart Failure Management, including Recently Approved Therapeutic Options: An Overview

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