Efficacy of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in the Treatment of Chronic Heart Failure: A Review of Landmark Trials

摘要

Heart failure (HF) is a multi-faceted clinical condition affecting up to 2% of the population in?the developed world and is linked?to significant morbidity and mortality,?therefore posing a major public health concern. To this date, pharmacotherapy for HF has mainly focused on chronic HF with reduced ejection fraction (HFrEF), with angiotensin converting enzyme inhibitors (ACEi) being at the centre?of the management plan, alongside angiotensin-receptor-blockers (ARBs), β-blockers (BB) and mineralocorticoid receptor antagonists (MRAs). A?novel and recently approved therapy, however,?involving?angiotensin receptor–neprilysin inhibitors (ARNI), has?shown very promising results and?comparable to those of ACEi, which raises the question of whether ACEi should remain the first-line treatment option for?HFrEF. In this review, the evidence regarding the clinical?efficacy of ACEi and?ARNI in the treatment of?HFrEF?is discussed, with emphasis placed on the major landmark?trials.