The PARADIGM-HF trial showed that sacubitril/valsartan was superior to enalapril in treating patients with heart failure and reduced ejection fraction (HFrEF). Among 8,442 participants, sacubitril/valsartan reduced the risk of cardiovascular death or hospitalization for heart failure to 21.8%, compared to 26.5% with enalapril. Other key findings included reductions in all-cause death and cardiovascular mortality. The treatment was especially beneficial across subgroups, including those with varying eGFR levels, and slowed heart failure progression while reducing the risk of sudden cardiac death. However, patients on sacubitril/valsartan had a higher rate of symptomatic hypotension but fewer cases of elevated serum creatinine, hyperkalemia, and cough.

The trial suggests that sacubitril/valsartan significantly improves HFrEF management compared to enalapril. This combined neprilysin inhibitor and angiotensin-receptor blocker reduced hospitalizations and mortality, while also slowing kidney function decline. Overall, sacubitril/valsartan marks a key advancement in heart failure care, offering additional benefits in glycemic control and cardiovascular health, making it an important option for these patients.

Reference: Bavry A. Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure – PARADIGM-HF. American College of Cardiology. Published August 30, 2024. Accessed September 12, 2024. https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2014/08/30/12/22/PARADIGM-HF