Does Angiotensin–Neprilysin Inhibition Provide Benefit in Heart Failure with Preserved Ejection Fraction?

A randomized trial suggests the answer is no.

Treatment of heart failure (HF) has evolved unevenly, with marked advances for HF with reduced ejection fraction (HFrEF) but little progress for HF with preserved ejection fraction (HFpEF). Based on the success of angiotensin receptor–neprilysin inhibition (ARNI) in reducing the risks for hospitalization and cardiovascular death in patients with HFrEF, investigators performed a manufacturer-sponsored trial (PARAGON-HF; NCT01920711) of this combination in patients with HFpEF. The 4,822 patients (mean age, 73; 36% with ischemic heart disease) had symptomatic heart failure, elevated natriuretic peptide levels, and structural heart disease with LVEF of at least 45%; they were randomized to receive ARNI (sacubitril/valsartan; target dose, 97 mg/…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)

Does Angiotensin–Neprilysin Inhibition Provide Benefit in Heart Failure with Preserved Ejection Fraction?

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Reviewing Author