Combined Neprilysin and Angiotensin Inhibitor for the Treatment of Heart Failure

Heart failure (HF) is a highly prevalent disease state worldwide that can progress into a disabling condition. It is pertinent to have a treatment regimen that is effective in lowering the number of HF exacerbations and, therefore, hospital readmission rates. A novel medication currently in clinical trials, LCZ696, blocks both neprilysin and angiotensin type I receptors. The overall effects are an inhibition of the breakdown of natriuretic peptides which leads to a decrease in renin and aldosterone release. This, combined with the antagonization of angiotensin type I receptors, leads to a decrease in blood pressure, blood volume and systemic vascular resistance. The PARAMOUNT trial compared the therapeutic effectiveness of LCZ696 to valsartan monotherapy. This study demonstrated that patients taking LCZ696 had better improvements in symptoms and biomarkers. The PARADIGM-HF trial compared LCZ696 to enalapril. LCZ696 showed significant reductions in cardiac death, hospitalizations and HF symptoms over enalapril. Although this new medication looks promising as a future treatment option for HF patients, additional studies should be completed to look at the long-term patient outcomes associated with LCZ696