What is the effect of sacubitril/valsartan on cardiovascular outcomes in symptomatic HFrEF?

• A. Increases risk of hospitalization.
• B. Reduces cardiovascular death and hospitalization in symptomatic HFrEF.
• C. No effect on mortality.
• D. Worsens blood pressure.

Answer: (B)

Sacubitril/valsartan improves outcomes in symptomatic HFrEF by lowering the risk of death from cardiovascular causes and reducing heart failure–related hospitalizations. This ARNI combines neprilysin inhibition (which boosts beneficial natriuretic peptides, causing vasodilation and natriuresis) with ARB-mediated suppression of the harmful RAAS, addressing both load and remodeling. In the pivotal trials, patients treated with sacubitril/valsartan had a meaningful reduction—about one-fifth—in the composite endpoint of cardiovascular death or HF hospitalization compared with an ACE inhibitor, and cardiovascular death itself was reduced as well. While it can lower blood pressure, the overall effect is a clear improvement in major cardiovascular outcomes, not a worsening of prognosis.