Angiotensin-neprilysin inhibition vs. enalapril in heart failure

Author(s): Naveen Jamwal, S. S. Tripathi, Malvika Misra

Background: This is a small trial where we compared the angiotensin receptor–neprilysin inhibitor ARNI with enalapril in patients with heart failure and reduced ejection fraction.

Methods: In this single centre trial, we randomly assigned 512 patients with class II, III Heart failure and an ejection fraction of 35% or less to receive either ARNI or enalapril. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure.

Results: Death from cardiovascular causes or hospitalization for heart failure (the primary endpoint) occurred in 42 patients in ARNI group compared to 63 in enalapril group (hazard ratio, 0.67; 95% CI, 0.47 to 0.94; p=0.022). 23 people died in ARNI and 31 in enalapril group due to cardiovascular causes (hazard ratio, 0.74; 95% CI, 0.44 to 1.21; p=0.251). 26 patients were hospitalized for heart failure in ARNI group, as compared with 36 patients receiving enalapril (hazard ratio, 0.72; 95% CI, 0.45 to 1.16; p=0.177). 33 patients in the ARNI group and 45 patients in the enalapril group died (hazard ratio for death from any cause, 0.74; 95% CI, 0.49 to 1.11; p=0.141).

Conclusion: ARNI was superior to enalapril in reducing the risks of death and of hospitalization for heart failure.