Shift of conventional paradigm of heart failure treatment: from angiotensin receptor neprilysin inhibitor to sodium-glucose co-transporter 2 inhibitors?

Future Cardiol. 2021 May;17(3):497-506. doi: 10.2217/fca-2020-0178. Epub 2021 Feb 22.

Abstract

Current clinical guidelines for heart failure (HF) contain a brand new therapeutic strategy for HF with reduced ejection fraction (HFrEF), which is based on neurohumoral modulation through the use of angiotensin receptor neprilysin inhibitors. There is a large body of evidence for the fact that sodium-glucose co-transporter 2 inhibitors may significantly improve all-cause mortality, cardiovascular mortality and hospitalization for HF in patients with HFrEF who received renin-angiotensin system blockers including angiotensin receptor neprilysin inhibitors, β-blockers and mineralocorticoid receptor antagonists. The review discusses that sodium-glucose co-transporter 2 inhibitors have a wide spectrum of favorable molecular effects and contribute to tissue protection, improving survival in HFrEF patients.

Keywords: angiotensin receptor neprilysin inhibitor; clinical outcomes; heart failure; prognosis; sodium-glucose co-transporter 2 inhibitors.

MeSH terms

  • Angiotensin Receptor Antagonists / therapeutic use
  • Drug Combinations
  • Glucose
  • Heart Failure* / drug therapy
  • Humans
  • Neprilysin
  • Receptors, Angiotensin
  • Sodium
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
  • Stroke Volume
  • Symporters*

Substances

  • Angiotensin Receptor Antagonists
  • Drug Combinations
  • Receptors, Angiotensin
  • Sodium-Glucose Transporter 2 Inhibitors
  • Symporters
  • Sodium
  • Neprilysin
  • Glucose