The neprilysin pathway in heart failure: a review and guide on the use of sacubitril/valsartan

摘要: Inhibition of neurohumoural pathways such as the renin angiotensin aldosterone and sympathetic nervous systems is central to understanding treatment heart failure (HF). Conversely, until recently, potentially beneficial augmentation natriuretic peptides has had limited therapeutic success. Administration synthetic not improved outcomes in acute HF but modulation system through inhibition enzyme that degrades (and other vasoactive) peptides, neprilysin, proven be successful. After initial failures with neprilysin alone or dual neprilysin-angiotensin converting (ACE) inhibition, Prospective comparison receptor inhibitor (ARNI) ACEI Determine Impact on Global Mortality morbidity Heart Failure trial (PARADIGM-HF) demonstrated mortality can blocker sacubitril/valsartan (formerly LCZ696). In ACE enalapril, reduced occurrence primary end point (cardiovascular death hospitalisation for HF) by 20% a 16% reduction all-cause mortality. These findings suggest should replace an foundation symptomatic patients (NYHA II–IV) ejection fraction. This review will explore background HF, results PARADIGM-HF offer guidance how use clinical practice.