Those who switched to sacubitril/valsartan from an ACE inhibitor had a lower risk of angioedema compared with new users of ACE inhibitors (HR 0.31; 95% CI 0.23-0.43), but there was no difference in ...

Heart Failure With Reduced Ejection Fraction: ARNI vs ACE Inhibitor and ARB. Nancy Hope Goodbar, PharmD, BCPS. Disclosures. August 02, 2016. Question .

The risk for angioedema increases when switching from an ARB or ACE inhibitor to ARNI, observational data suggest. Better to start RAS inhibition using the ARNI in the first place, researchers say.

PIONEER-HF, observed James L. Januzzi Jr, MD, Massachusetts General Hospital, Boston, is in large part "a test of switching from an ACE inhibitor or ARB, after stabilization, to sacubitril ...

"Current estimates suggest that ACE-I/ARB usage in HFrEF is about 60-80%; ARNI usage is just above 10%; BB [beta blocker] usage is about 60-80%; and MRA usage is about 30-60%.

Source Reference: Tan NY, et al "Comparative effectiveness of sacubitril-valsartan versus ACE/ARB therapy in heart failure with reduced ejection fraction" JACC Heart Fail 2019; DOI: 10.1016/j.jchf ...

An increased adverse-effect risk in a pooled analysis of trials is said to argue against combining the drug classes, at least routinely, in heart failure and LV dysfunction. (Phillips CO et al ...

ACE inhibitors and angiotensin II receptor blockers ARBs may slow down increased solute transport in a study of Dutch peritoneal dialysis patients.

Hence, “although the incidence of ARB-induced angioedema is low, it can still occur and can be potentially life-threatening” (J Clin Hypertens [Greenwich]. 2008;10:949-50).

The short answer is yes. There is an increasing realization that angiotensin II can be produced from non-ACE-mediated pathways involving enzymes such as chymases, among others. Consequently, ACE ...

An ARB was as efficacious as an ACE inhibitor, but combination therapy failed to show any advantages. Angiotensin-converting-enzyme inhibitors lower the incidence of adverse cardiovascular events ...