From ACE Inhibitors/ARBs to ARNIs in Coronary Artery Disease and Heart Failure (Part 2/5)

J Am Coll Cardiol. 2019 Aug 6;74(5):683-698. doi: 10.1016/j.jacc.2019.04.068.

Abstract

The pharmacological inhibition of the renin-angiotensin-aldosterone system as a therapeutic strategy is one of the most significant advances in the treatment and prevention of cardiovascular disease in heart failure with reduced ejection fraction and in coronary artery disease. Recently, the addition of neprilysin inhibition to angiotensin receptor blockade has been shown to be even more effective than angiotensin-converting enzyme inhibition alone in heart failure with reduced ejection fraction, marking an important new milestone in heart failure treatment. This review summarizes the major trials that have informed the clinical role of inhibition of the renin-angiotensin-aldosterone and neprilysin pathways, as well as the limitations of these strategies.

Keywords: ACE-I; ARB; ARNI; coronary disease; heart failure.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / physiopathology
  • Drug Therapy, Combination
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Humans
  • Renin-Angiotensin System / drug effects*
  • Stroke Volume / physiology*

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors