Fig. 3.

Mechanism of action: Sacubitril/valsartan has the mechanism of action of neprilisin inhibitor and angiotensin II receptor blocker type-1 (AT1). The complementary cardiovascular benefits of sacubitril/valsartan are attributed to the increase in neprilisin-degraded peptides and the simultaneous inhibition of the effects of angiotensin II. Natriuretic peptides exert their effects through the activation of membrane bound receptors coupled to the enzyme guanylyl cyclase, causing an increase in concentrations of the second messenger, cyclic guanosine monophosphate (cGMP), which can lead to vasodilation, natriuresis and diuresis, increased glomerular filtration rate and renal blood flow, inhibition of renin and aldosterone release, reduction of sympathetic activity and antihypertrophic/antifibrotic effects.