Congestive heart failure angiotensin receptor-neprilysin inhibitor: Difference between revisions
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Animal studies revealed that the effect of [[neprilysin]] inhibition is further potentiated with the concomitant inhibition of the [[renin angiotensin system]] by the administration of [[ACE inhibitor]]s at the expense of an increased risk of [[angioedema]].<ref name="pmid9456286">{{cite journal| author=Rademaker MT, Charles CJ, Espiner EA, Nicholls MG, Richards AM, Kosoglou T| title=Combined neutral endopeptidase and angiotensin-converting enzyme inhibition in heart failure: role of natriuretic peptides and angiotensin II. | journal=J Cardiovasc Pharmacol | year= 1998 | volume= 31 | issue= 1 | pages= 116-25 | pmid=9456286 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9456286 }} </ref> The PARADIGM-HF study evaluated the efficacy of LCZ696, a concomitant inhibitor of neprilysin and [[angiotensin]] receptor, on the rate of mortality due to cardiovascular causes and hospitalizations. PARADIGM-HF randomized 8442 chronic heart failure patients with an [[ejection fraction]] inferior to 40% to either [[enalapril]] or angiotensin receptor-neprilysin inhibitor. Compared to [[enalapril]], [[angiotensin receptor]]-[[neprilysin]] inhibitor significantly reduced the rate of [[hospitalization]] by 21% and decreased the rate of cardiovascular and hospitalization-related deaths from 26.5% to 21.8%. The administration of [[angiotensin receptor]]-[[neprilysin]] inhibitor reduced chronic heart failure symptoms and the associated limitation of physical activity.<ref name=NEJM>J. McMurray, M. Packer, M.D., A.S. Desai, M.D. Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure. New England Journal of Medicine. Epub ahead of print. Accessed on August 30, 2014. </ref> | Animal studies revealed that the effect of [[neprilysin]] inhibition is further potentiated with the concomitant inhibition of the [[renin angiotensin system]] by the administration of [[ACE inhibitor]]s at the expense of an increased risk of [[angioedema]].<ref name="pmid9456286">{{cite journal| author=Rademaker MT, Charles CJ, Espiner EA, Nicholls MG, Richards AM, Kosoglou T| title=Combined neutral endopeptidase and angiotensin-converting enzyme inhibition in heart failure: role of natriuretic peptides and angiotensin II. | journal=J Cardiovasc Pharmacol | year= 1998 | volume= 31 | issue= 1 | pages= 116-25 | pmid=9456286 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9456286 }} </ref> The PARADIGM-HF study evaluated the efficacy of LCZ696, a concomitant inhibitor of neprilysin and [[angiotensin]] receptor, on the rate of mortality due to cardiovascular causes and hospitalizations. PARADIGM-HF randomized 8442 chronic heart failure patients with an [[ejection fraction]] inferior to 40% to either [[enalapril]] or angiotensin receptor-neprilysin inhibitor. Compared to [[enalapril]], [[angiotensin receptor]]-[[neprilysin]] inhibitor significantly reduced the rate of [[hospitalization]] by 21% and decreased the rate of cardiovascular and hospitalization-related deaths from 26.5% to 21.8%. The administration of [[angiotensin receptor]]-[[neprilysin]] inhibitor reduced chronic heart failure symptoms and the associated limitation of physical activity.<ref name=NEJM>J. McMurray, M. Packer, M.D., A.S. Desai, M.D. Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure. New England Journal of Medicine. Epub ahead of print. Accessed on August 30, 2014. </ref> | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki> In patients with chronic symptomatic [[Congestive heart failure classification#Classification of Heart Failure Based on the Ejection Fraction (EF)|HFrEF]] NYHA class II or III who tolerate an ACE inhibitor or ARB, replacement by an [[Congestive heart failure angiotensin receptor-neprilysin inhibitor|ARNI]] is recommended to further reduce morbidity and mortality. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Class I, Level of Evidence: B-R]])<ref name="pmid25176015">{{cite journal |vauthors=McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR |title=Angiotensin-neprilysin inhibition versus enalapril in heart failure |journal=N. Engl. J. Med. |volume=371 |issue=11 |pages=993–1004 |year=2014 |pmid=25176015 |doi=10.1056/NEJMoa1409077 |url=}}</ref>'' <nowiki>"</nowiki> | |||
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| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm) | |||
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|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' [[Congestive heart failure angiotensin receptor-neprilysin inhibitor|ARNI]] should not be administered concomitantly with [[ACE inhibitor|ACE inhibitors]] or within 36 hours of the last dose of an ACE inhibitor. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])<ref name="pmid12186794">{{cite journal |vauthors=Packer M, Califf RM, Konstam MA, Krum H, McMurray JJ, Rouleau JL, Swedberg K |title=Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE) |journal=Circulation |volume=106 |issue=8 |pages=920–6 |year=2002 |pmid=12186794 |doi= |url=}}</ref><ref name="pmid14751650">{{cite journal |vauthors=Kostis JB, Packer M, Black HR, Schmieder R, Henry D, Levy E |title=Omapatrilat and enalapril in patients with hypertension: the Omapatrilat Cardiovascular Treatment vs. Enalapril (OCTAVE) trial |journal=Am. J. Hypertens. |volume=17 |issue=2 |pages=103–11 |year=2004 |pmid=14751650 |doi= |url=}}</ref>'' <nowiki>"</nowiki> | |||
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|bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' [[Congestive heart failure angiotensin receptor-neprilysin inhibitor|ARNI]] should not be administered to patients with a history of [[angioedema]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])'' <nowiki>"</nowiki> | |||
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==References== | ==References== | ||
Revision as of 20:09, 26 October 2016
 |
Resident Survival Guide |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
The PARADIGM-HF study evaluated the efficacy of LCZ696, a concomitant inhibitor of neprilysin and angiotensin receptor, on the rate of mortality due to cardiovascular causes and hospitalization. Compared to enalapril, angiotensin receptor-neprilysin inhibitor significantly reduced the rate of hospitalization by 21% and decreased the rate of cardiovascular and hospitalization-related deaths from 26.5% to 21.8%. The administration of angiotensin receptor-neprilysin inhibitor reduced chronic heart failure symptoms and the associated limitation of physical activity.[1]
Angiotensin Receptor-Neprilysin Inhibitor
The inhibition of neprilysin, a neutral endopeptidase, has been associated with a decrease in vasoactive peptides among patients with heart failure. In fact, neprilysin inhibition decreases the breakdown of natriuretic peptide, bradykinin, and adrenomedullin leading to an attenuation of sodium retention and vasoconstriction observed in heart failure patients.[2][3][4]
Animal studies revealed that the effect of neprilysin inhibition is further potentiated with the concomitant inhibition of the renin angiotensin system by the administration of ACE inhibitors at the expense of an increased risk of angioedema.[5] The PARADIGM-HF study evaluated the efficacy of LCZ696, a concomitant inhibitor of neprilysin and angiotensin receptor, on the rate of mortality due to cardiovascular causes and hospitalizations. PARADIGM-HF randomized 8442 chronic heart failure patients with an ejection fraction inferior to 40% to either enalapril or angiotensin receptor-neprilysin inhibitor. Compared to enalapril, angiotensin receptor-neprilysin inhibitor significantly reduced the rate of hospitalization by 21% and decreased the rate of cardiovascular and hospitalization-related deaths from 26.5% to 21.8%. The administration of angiotensin receptor-neprilysin inhibitor reduced chronic heart failure symptoms and the associated limitation of physical activity.[1]
| Class I |
| " In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACE inhibitor or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality. (Class I, Level of Evidence: B-R)[6] " |
| Class III (Harm) |
| "2. ARNI should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor. (Level of Evidence: B-R)[7][8] " |
| "3. ARNI should not be administered to patients with a history of angioedema. (Level of Evidence: C-EO) " |
References
- ↑ 1.0 1.1 J. McMurray, M. Packer, M.D., A.S. Desai, M.D. Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure. New England Journal of Medicine. Epub ahead of print. Accessed on August 30, 2014.
- ↑ Cruden NL, Fox KA, Ludlam CA, Johnston NR, Newby DE (2004). "Neutral endopeptidase inhibition augments vascular actions of bradykinin in patients treated with angiotensin-converting enzyme inhibition". Hypertension. 44 (6): 913–8. doi:10.1161/01.HYP.0000146483.78994.56. PMID 15492133.
- ↑ Rademaker MT, Charles CJ, Espiner EA, Nicholls MG, Richards AM, Kosoglou T (1996). "Neutral endopeptidase inhibition: augmented atrial and brain natriuretic peptide, haemodynamic and natriuretic responses in ovine heart failure". Clin Sci (Lond). 91 (3): 283–91. PMID 8869410.
- ↑ Wilkinson IB, McEniery CM, Bongaerts KH, MacCallum H, Webb DJ, Cockcroft JR (2001). "Adrenomedullin (ADM) in the human forearm vascular bed: effect of neutral endopeptidase inhibition and comparison with proadrenomedullin NH2-terminal 20 peptide (PAMP)". Br J Clin Pharmacol. 52 (2): 159–64. PMC 2014526. PMID 11488772.
- ↑ Rademaker MT, Charles CJ, Espiner EA, Nicholls MG, Richards AM, Kosoglou T (1998). "Combined neutral endopeptidase and angiotensin-converting enzyme inhibition in heart failure: role of natriuretic peptides and angiotensin II". J Cardiovasc Pharmacol. 31 (1): 116–25. PMID 9456286.
- ↑ McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR (2014). "Angiotensin-neprilysin inhibition versus enalapril in heart failure". N. Engl. J. Med. 371 (11): 993–1004. doi:10.1056/NEJMoa1409077. PMID 25176015.
- ↑ Packer M, Califf RM, Konstam MA, Krum H, McMurray JJ, Rouleau JL, Swedberg K (2002). "Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE)". Circulation. 106 (8): 920–6. PMID 12186794.
- ↑ Kostis JB, Packer M, Black HR, Schmieder R, Henry D, Levy E (2004). "Omapatrilat and enalapril in patients with hypertension: the Omapatrilat Cardiovascular Treatment vs. Enalapril (OCTAVE) trial". Am. J. Hypertens. 17 (2): 103–11. PMID 14751650.