title: Sacubitril/Valsartan: A Novel Cardiovascular Combination Agent.
abstract: Sacubitril/valsartan [LCZ696 (Entresto), Novartis Pharmaceuticals Corp.] is the first in a new class of drugs that combines neprilysin inhibition with angiotensin II receptor antagonism, the combination of which acts to increase endogenous natriuretic peptides while inhibiting the renin-angiotensin-aldosterone system. Sacubitril/valsartan has been studied in the treatment of hypertension, heart failure with reduced ejection fraction (HFrEF), and heart failure with preserved ejection fraction (HFpEF) and has demonstrated clinical efficacy in blood pressure reduction in hypertensive patients with and without HFpEF and a reduction in hospitalizations and mortality for patients with HFrEF. Research to evaluate clinical outcomes in HFpEF is ongoing. Sacubitril/valsartan is approved to reduce hospitalization and risk of cardiovascular death for patients with HFrEF in New York Heart Association (NYHA) functional class II-IV. The product is as well tolerated as an angiotensin-converting enzyme inhibitor, with the most common side effect being hypotension. Expectedly, it is much more costly than generic angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, which will be a factor in determining how widespread the use of this agent will be. In summary, although the number of published studies evaluating its use is limited, sacubitril/valsartan represents a promising new treatment option for patients with HFrEF. Ongoing studies will continue to refine the role of this agent in clinical practice.
authors.affiliation: From the *Department of Pharmacy, University of New Mexico, Albuquerque, NM; and †Department of Medicine, North Shore-Long Island Jewish Health System, Great Neck, NY.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Sible
authors.forename: James J
authors.initials: JJ
authors.lastname: Nawarskas
authors.forename: David
authors.initials: D
authors.lastname: Alajajian
authors.forename: Joe R
authors.initials: JR
authors.lastname: Anderson
mesh_terms: D000613:Aminobutyrates / Q000494:pharmacology / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D004338:Drug Combinations; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D045265:Natriuretic Peptides / Q000378:metabolism; D015260:Neprilysin / Q000037:antagonists & inhibitors* / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects; D013318:Stroke Volume; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use*; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D004338:Drug Combinations; D004791:Enzyme Inhibitors; D045265:Natriuretic Peptides; D013777:Tetrazoles; D000068756:Valsartan; D015260:Neprilysin; C549068:sacubitril and valsartan sodium hydrate drug combination