Congestive Heart Failure (CHF) Practice Test

Sacubitril/valsartan is an ARNI, combining neprilysin inhibition with angiotensin receptor blockade. Neprilysin inhibition raises natriuretic peptides, producing vasodilation, natriuresis, and anti-remodeling effects, while the valsartan component blocks angiotensin II’s harmful actions. Together, this improves outcomes in HFrEF beyond what ACE inhibitors alone provide. This benefit was shown in the PARADIGM-HF trial, which compared sacubitril/valsartan with enalapril in about 8,400 patients with symptomatic heart failure and reduced ejection fraction. It demonstrated a relative reduction around 20% in the primary outcome of cardiovascular death or heart failure hospitalization, and also lowered all-cause mortality, establishing superiority over an ACE inhibitor. Because of this, guidelines endorse using sacubitril/valsartan in eligible patients to improve outcomes, with a required washout period when switching from an ACE inhibitor to minimize angioedema risk.