Angiotensin receptor blockers and neprilysin inhibitors

What are Angiotensin receptor blockers and neprilysin inhibitors?

Angiotensin receptor blockers with neprilysin inhibitors is a combination medicine that contains both an angiotensin receptor blocker and a neprilysin inhibitor.

How they work

Angiotensin receptor blockers (ARBs) inhibit the activation of angiotensin II receptor which causes vasodilation, a reduction of aldosterone production and reduced vasopressin release which results in a reduction in blood pressure.

Neprilysin inhibition causes an increase in levels of natriuretic peptides which is important in maintaining fluid and sodium balance through natriuresis, diuresis and vasodilation which reduces blood pressure and assists heart failure.

What they treat

The combination of angiotensin receptor blockers and neprilysin inhibitors are used to reduce risk of complications of heart failure with reduced ejection fraction.

ARNI, or an angiotensin receptor/neprilysin inhibitor, is made up of two drugs put together to treat heart failure. It contains an ARB (angiotensin II receptor blocker) and a neprilysin inhibitor. Sacubitril/valsartan is the only ARNI drug available now. The Food and Drug Administration approved the drug in 2015.

However, because neprilysin breaks down angiotensin II, inhibiting neprilysin will accumulate angiotensin II. For this reason, a neprilysin inhibitor cannot be used alone; it should be combined with an ARB to block the effect of the excess angiotensin II.