Angiotensin Receptor–Neprilysin Inhibition

New Therapeutic Concept for the Management of Chronic Heart Failure Development, Clinical Implications, and Future Perspectives

Havakuk, Ofer MD
Elkayam, Uri MD

¹Division of Cardiovascular Medicine, Department of Medicine, LAC/USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

Uri Elkayam, Division of Cardiovascular Medicine, Department of Medicine, LAC/USC Medical Center, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, Los Angeles, CA 90033, USA. Email: [email protected]

* Sharon Hale served as the Guest Editor on this paper.

Received August 30, 2016

Accepted November 1, 2016

Journal of Cardiovascular Pharmacology and Therapeutics 22(4):p 356-364, July 2017. | DOI: 10.1177/1074248416683049

The novel combination sacubitril/valsartan represents a new therapeutic approach in the management of heart failure. With the simultaneous blockage of the enzyme neprilysin (by sacubitril) and angiotensin II receptors (by valsartan), this combination reduces the degradation of natriuretic peptides and other counterregulatory peptide systems while avoiding the deleterious effect of angiotensin II receptors activation and thereby encompasses a beneficial impact of 2 important neurohormonal pathways activated in heart failure. As opposed to previously tested neprilysin inhibitors, sacubitril/valsartan represents a more effective method in reducing morbidity and mortality in heart failure, while preserving a safety profile comparable to well-established, standard, angiotensin-converting enzyme inhibitor’s therapy.