sacubitril-valsartan

Sacubitril-valsartan is a two-in-one heart-failure pill that improves survival in people whose heart muscle pumps weakly. It pairs a familiar angiotensin receptor blocker with a newer partner, working two beneficial angles of the same problem at once.

The valsartan half blocks the harmful vessel-tightening, fluid-retaining angiotensin pathway, just like other ARBs. The sacubitril half blocks an enzyme called neprilysin, which normally breaks down the body's own beneficial natriuretic peptides — protective hormones that relax vessels and help shed salt and water. Together this class is called an ARNI.

In a landmark trial it outperformed a standard ACE inhibitor at reducing deaths and hospitalizations in heart failure with reduced ejection fraction, and it is now a guideline-recommended replacement for an ACE inhibitor or ARB in suitable patients.

Two important rules follow from how it works. It must never be combined with an ACE inhibitor, and a washout gap is required when switching, because overlapping the two raises the risk of angioedema; like the drugs it builds on, it can lower blood pressure and raise potassium.