ARNI Therapy in Heart Failure and Hypertension: Sacubitril/Valsartan Across the CVD Continuum

About

Cardiovascular disease remains the leading cause of mortality worldwide and in Hong Kong, with hypertension serving as one of the most important modifiable risk factors. Uncontrolled hypertension drives progression along the cardiovascular continuum, leading to left ventricular hypertrophy and eventually heart failure.

Despite decades of available therapies, uncontrolled and resistant hypertension remain prevalent, contributing to poor cardiovascular outcomes. Sacubitril/valsartan, an angiotensin-neprilysin inhibitor (ARNI), represents a breakthrough in heart failure treatment. By combining neprilysin inhibition with renin-angiotensin-aldosterone system (RAAS) blockade, it improves neurohormonal balance, reduces cardiovascular death and hospitalization, and demonstrates significant benefits across global and local studies.

Beyond heart failure, ARNI therapy provides robust blood pressure reduction, regression of left ventricular hypertrophy, renal protection, and particular benefit in nocturnal and salt-sensitive hypertension. In this way, sacubitril/valsartan bridges the continuum from prevention to treatment, offering dual benefits in hypertension and heart failure. Its integration into practice represents a paradigm shift in cardiovascular care with the potential to improve survival and quality of life across diverse patient populations.

This CME explores the global and local burden of hypertension and heart failure, with emphasis on their close relationship in the cardiovascular continuum. It highlights challenges in blood pressure control, regional differences in prevention strategies, and the rising impact of resistant hypertension. Evidence on sacubitril/valsartan (ARNI) will be reviewed, including its dual role in improving heart failure outcomes and providing strong antihypertensive, structural, and renal benefits.