Objective: Dual neprilysin inhibition and angiotensin receptor blockade with LCZ696 has been shown therapeutic benefits in chronic heart failure (CHF) patients. The aim of the study was to assess sacubitril/valsartan effects on parameters of arterial stiffness in stable heart failure with reduced ejection fraction (HFrEF).

Methods: In the open-label follow-up to PARADIGM HF study 18 patients with stable HFrEF (16 male, 699 years (MSD), arterial hypertension 83%, previous myocardial infarction 89%, diabetes mellitus 39%, dyslipidemia 56%, LVEF 324%, serum creatinine 11821 μmol/l, eGFR 5613 ml/min/1.73m², potassium 4.450.35 mmol/l) were enrolled. Patients received a stable background treatment for at least a month (ACEI 94%, beta-blockers 100%, aldosterone receptor antagonists 83.3%, loop diuretics 72.2%). Applanation tonometry was performed baseline and after 6 month LCZ696 therapy. Wilcoxon test was considered significant if p<0.05.

Results: Baseline brachial BP decreased from 137.1±22.0/83.4±11.8 to 120.5±13.5/75.1±9.3 mmHg (Δ −16.6±14.2/−8.3±10.3 mmHg, p<0.05), heart rate did not change (78±12 vs 75±15 beats/min (Δ −2.7±14.7 beats/min, p>0.05). Valsartan/sacubitril therapy was associated with significant decrease of carotid-femoral pulse wave velocity (11.5±2.9 vs 10.2±2.9 m/s, p<0.05), central systolic (125±16 vs 116±15 mmHg, p=0.005) and diastolic (78±7 vs 74±9 mmHg, p<0.05) blood pressure. Central pulse pressure (45±11 vs 41±16 mmHg), augmentation pressure (16±7,1 vs 13,8±8,4 mmHg), augmentation index (29±7 vs 28±11%), time to reflected wave (128±8 vs 132±7 ms) did not change significantly (p>0.05 for all comparisons).

Conclusion: 6 month sacubitril/valsartan therapy was associated with significant decrease of aortic systolic pressure and pulse wave velocity.