Sacubitril/Valsartan: A Modern Standard in HFREF and HFPEF Therapy

Course overview

Sacubitril/valsartan is a dual-acting angiotensin receptor-neprilysin inhibitor approved for treating heart failure with reduced and preserved ejection fraction. By combining neprilysin inhibition with angiotensin II receptor blockade, it enhances vasodilation, natriuresis, and neurohormonal suppression, leading to improved clinical outcomes. It is recommended in current guidelines as a preferred therapy for eligible patients with HFrEF. A recent pooled analysis of the PIONEER-HF and PARAGLIDE-HF trials supports early in-hospital initiation to reduce short-term cardiovascular events across a range of ejection fractions. Key considerations include appropriate dosing, adverse effect monitoring, and cautious interpretation of NT-proBNP during therapy.