Physicians' Academy for Cardiovascular Education

Greater reduction in NT-proBNP with ARNI compared to ARB in HFmrEF/HFpEF after worsening HF event

News - May 22, 2023

PARAGLIDEHF: Sacubitril/Valsartan versus valsartan on changes in NTproBNP, safety, and tolerability in patients with EF>40% stabilized after a WHF Event

Presented at ESC Heart Failure 2023 by: Robert Mentz, MD - Durham, NC, USA

Introduction and methods


Sacubitril/valsartan is recommended by several society guidelines to reduce hospitalizations in HFmrEF and HFpEF. A post-hoc analysis of the PARAGON-HF trial suggested that sacubitril/valsartan has greater benefits in patients who were recently hospitalized. However, It remained unclear whether initiation of sacubitril/valsartan is safe and effective in patients with HF and EF >40% stabilized after a worsening HF (WHF) event.

Aim of the study

The authors compared the effects of sacubitril/valsartan with valsartan in patients with HFmrEF or HFpEF who had experienced a recent WHF event.



In the PARAGLIDE-HF trial patients (n=466) with HFmrEF and HFpEF with a recent WHF event were included. A recent WHF was defined as hospitalization, a urgent HF visit or a ER visit within 30 days of randomization. Patients were eligible if they had: SBP ≥100 mmHg; NT-proBNP ≥500 pg/mL; GFR ≥20 ml/min/1.73m²; and K ≤5.2 mEq/L. Patients were randomized to 96 mg/103 mg sacubitril/valsartan twice daily or 160 mg valsartan twice daily (n=233 in each group).


The primary endpoint was the proportional change in NT-proBNP from baseline to weeks 4 and 8.

Main results

Primary endpoint

Secondary endpoints

Subgroup analysis


In patients with EF>40% who were stabilized after recent WHF, treatment with sacubitril/valsartan led to greater reductions in NT-proBNP compared to treatment with valsartan. The win ratio in the hierarchical CV composite outcome tended to be in favor of sacubitril/valsartan compared to valsartan. In addition, sacubitril/valsartan was associated with a lower rate of worsening renal function, but with a higher rate of symptomatic hypertension.

-Our reporting is based on the information provided at ESC Heart Failure 2023 –

The findings of this study were simultaneously published in J Am Coll Cardiol. 2023

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