Angiotensin Receptor-Neprilysin Inhibitor (ARNi) – Sacubitril/Valsartan
Angiotensin Receptor-Neprilysin Inhibitor (ARNi) has been specifically designed to treat heart failure. It consists of 2 components that work together: an angiotensin II receptor blocker and a neprilysin inhibitor.
Studies have shown that ARNi may improve length of life and reduce the risk of being re-hospitalised for heart failure. ARNi is currently used for the treatment of patients with heart failure with reduced ejection fraction, which means reduced function of the main pumping chamber.
What they do: The two active substances, sacubitril and valsartan, work in different ways. Valsartan blocks the action of a hormone from the kidney called angiotensin II, which can be harmful in patients with heart failure. This effect stops the hormone’s harmful effects on the heart, and it allows blood vessels to dilate or widen.
Sacubitril blocks the breakdown of natriuretic peptides produced in the body. Natriuretic peptides cause sodium and water to pass into the urine. This effect reduces the work on the heart and reduces blood pressure. The combined effect of the two medicines reduces the strain of the failing heart.
What are the expected benefits? Sacubitril/valsartan has been shown to help people to live longer, reduce hospitalisations for decompensated heart failure, and improve symptoms and quality of life.
Side effects: ARNI treatment is well tolerated. Mild dizziness may occur especially at the beginning of treatment. Low blood pressure can also occur. You may keep your blood pressure from getting too low by taking other blood pressure medicines at different times than your ARNi dose. Talk with your healthcare professional about spreading out the timing of your blood pressure medicines. This side effect normally disappears within 14 days. If not, your provider may advise to take a smaller dose of ARNi.
Top tips: The most recent ESC Guidelines recommend that sacubitril/valsartan be prescribed to heart failure patients who are still symptomatic despite treatment with full dose ACE-inhibitor or ARB. Yet, ARNi may also be considered in symptomatic patients with a reduced ejection fraction who have not been previously treated with an ACE inhibitor or ARB. It must not be taken by patients currently taking ACE-inhibitors or angiotensin receptor blockers (ARBs).”
