Figure 5.

Additional benefit of an angiotensin–neprilysin inhibitor on cardiovascular death compared to an angiotensin-receptor blocker and an ACE inhibitor.

Notes: The CHARM (candesartan in heart failure – assessment of mortality and morbidity) alternative trial compared an angiotensin-receptor blocker with placebo,110 the SOLVD (effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure) treatment trial compared an ACE inhibitor with placebo,15 and the PARADIGM-HF (prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure) trial compared an angiotensin–neprilysin inhibitor with an ACE inhibitor.29 Adapted with permission of Portland Press Ltd, from The natriuretic peptides system in the pathophysiology of heart failure: from molecular basis to treatment, Volpe M, Carnovali M, Mastromarino V, Clin Sci (Lond), 130(2), © 2016; permission conveyed through Copyright Clearance Center, Inc.36

Abbreviation: ACE, angiotensin-converting enzyme.