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Is sacubitril-valsartan effective for systolic heart failure (HF)?
If 36 patients with HF are switched from angiotensin-converting enzyme inhibitors (ACEIs) to sacubitril-valsartan, 1 fewer dies and 1 fewer is admitted for HF over 27 months. Aldosterone antagonists and β-blockers should be given first and continued concurrently.
To switch between sacubitril-valsartan and ACEIs, a 36-hour washout is recommended to prevent angioedema.6 The valsartan in the 50-, 100-, and 200-mg combinations is equivalent to common valsartan doses of 40, 80, and 160 mg.6 Sacubitril-valsartan might have stronger diuretic and natriuretic effects than valsartan alone,9 and blood pressure, fluid status, and diuretic dose should be monitored. Sacubitril-valsartan raises BNP levels. If natriuretic peptide measurement is needed, N-terminal pro-BNP level is preferred, as it is not affected by sacubitril-valsartan.6
Tools for Practice articles in Canadian Family Physician (CFP) are adapted from articles published on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in CFP are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician and are peer reviewed. Feedback is welcome and can be sent to ac.cpfc@ecitcarprofsloot. Archived articles are available on the ACFP website: www.acfp.ca.
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Cet article se trouve aussi en français à la page 698.
The opinions expressed in Tools for Practice articles are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.