- Question
- Is it safe and effective to start sacubitril-valsartan during hospitalization for acute decompensated heart failure, compared with enalapril?
- Design
- Randomized, double-blind, active-controlled trial enrolling 881 patients at 129 sites in the United States. Randomization occurred after hemodynamic stabilization; follow-up was 8 weeks.
- Population
- Patients with heart failure with reduced ejection fraction hospitalized for acute decompensated heart failure and hemodynamically stabilized.
- Intervention
- Sacubitril-valsartan titrated to a target dose of 97 mg sacubitril with 103 mg valsartan twice daily.
- Control
- Enalapril titrated to a target dose of 10 mg twice daily.
- Primary outcome
- Time-averaged proportional change in NT-proBNP concentration from baseline through weeks 4 and 8.
- Results
- NT-proBNP reduction was greater with sacubitril-valsartan than with enalapril (-46.7% vs. -25.3%; ratio of change 0.71; 95% CI 0.63 to 0.81; P<0.001). The difference was already evident at week 1 (ratio of change 0.76; 95% CI 0.69 to 0.85).
- Safety
- Rates of worsening renal function, hyperkalemia, symptomatic hypotension, and angioedema did not differ significantly between the two groups.
- Conclusion
- In patients hospitalized for acute decompensated heart failure with reduced ejection fraction, starting sacubitril-valsartan lowered NT-proBNP more than enalapril, with a similar safety profile.
- Why it matters
- It supported starting the angiotensin receptor-neprilysin inhibitor in hospital once patients are stabilized, rather than waiting until discharge or starting with an ACE inhibitor first.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026