Neurohormonal modulation: The new paradigm of pharmacological treatment of heart failure

Publication date: March 2019Source: Revista Portuguesa de Cardiologia (English Edition), Volume 38, Issue 3Author(s): J. Silva-Cardoso, D. Brás, F. Canário-Almeida, A. Andrade, L. Oliveira, F. Pádua, C. Fonseca, N. Bragança, S. Carvalho, R. Soares, J. Ferreira SantosAbstractThe current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%.Stimulation of counter-regulatory systems in addition to neurohormonal blockade constitutes a new paradigm, termed neurohormonal modulation. Sacubitril/valsartan is the first element of this new strategy.PARADIGM-HF was the largest randomized clinical trial conducted in HFrEF. It included 8442 patients and compared the efficacy and safety of sacubitril/valsartan versus enalapril. The primary endpoint was the composite of cardiovascular mortality and hospitalization due to HF, which occurred in 914 (21.8%) patients receiving sacubitril/valsartan and in 1117 (26.5%) patients receiving enalapril (HR 0.8, 95% CI 0.73-0.87, p=0.0000002; NNT 21). Sacubitril/valsartan reduced both primary endpoint components, as well as sudden cardiac death, death due to worsening HF, and death from all causes. Patients on sacubitril/valsartan reported less frequent deterioration of HF and of quality of life, and discontinued s...
Source: Revista Portuguesa de Cardiologia - Category: Cardiology Source Type: research