The role of angiotensin receptor–neprilysin inhibitors in cardiovascular disease—existing evidence, knowledge gaps, and future directions

Ambrosy, A. P., Mentz, R. J., Fiuzat, M., Cleland, J. G.F. , Greene, S. J., O'Connor, C. M., Teerlink, J. R., Zannad, F. and Solomon, S. D. (2018) The role of angiotensin receptor–neprilysin inhibitors in cardiovascular disease—existing evidence, knowledge gaps, and future directions. European Journal of Heart Failure, 20(6), pp. 963-972. (doi:10.1002/ejhf.1159) (PMID:29464817)

Ambrosy, A. P., Mentz, R. J., Fiuzat, M., Cleland, J. G.F. , Greene, S. J., O'Connor, C. M., Teerlink, J. R., Zannad, F. and Solomon, S. D. (2018) The role of angiotensin receptor–neprilysin inhibitors in cardiovascular disease—existing evidence, knowledge gaps, and future directions. European Journal of Heart Failure, 20(6), pp. 963-972. (doi:10.1002/ejhf.1159) (PMID:29464817)

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Abstract

Although traditional renin–angiotensin system antagonists including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have revolutionized the treatment of cardiovascular disease (CVD), the pivotal PARADIGM-HF trial demonstrated that sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), was superior to an angiotensin-converting enzyme inhibitor in reducing cardiovascular morbidity and mortality in patients with heart failure and reduced ejection fraction. However, despite international regulatory approval and strong recommendations in the guidelines, uptake of sacubitril/valsartan has been disappointing. Sacubitril/valsartan is now the focus of a large programme of clinical trials testing the hypothesis that ARNIs may supplant conventional renin–angiotensin system inhibitors across the spectrum of CVD, including hypertension, secondary prevention after myocardial infarction, and heart failure with preserved ejection fraction. This review summarizes the existing evidence, knowledge gaps, and future directions of ARNIs in CVD based on discussions between clinical trialists, industry representatives, and regulatory authorities at the 2016 Global CardioVascular Clinical Trialists Forum in Washington, D.C.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Ambrosy, A. P., Mentz, R. J., Fiuzat, M., Cleland, J. G.F., Greene, S. J., O'Connor, C. M., Teerlink, J. R., Zannad, F., and Solomon, S. D.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:21 February 2018
Copyright Holders:Copyright © 2018 The Authors and European Society of Cardiology
First Published:First published in European Journal of Heart Failure 20(6): 963-972
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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