Published on behalf of the European Society of Cardiology. Those results open the door to investigate angiotensin aldosterone and peptidases inhibition efficacy in the unexplored HF middle range ejection fraction, currently lacking of valid evidence.Ĭandesartan Heart failure hospitalization Heart failure with preserved ejection fraction Neutral endopeptidase Neutroptidases Sacubitril valsartan. The data were consistent with previous post hoc analysis performed in studies where candesartan and spironolactone were investigated in HFpEF. A subgroup analysis addressed significant decrease of HFH in subjects with left ventricular ejection fraction below the median 57% value in the study. The trial missed the primary outcome of cardiovascular death and HF hospitalization (HFH) in the overall study population. The PARAGON-HF ( number, NCT01920711) investigated HF subjects class II to IV HF, ejection fraction of 45% or higher, elevated level of natriuretic peptides, and structural heart disease to receive sacubitril-valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily) or valsartan (target dose, 160 mg twice daily). The innovative therapeutic concept provided by sacubitril-valsartan, a molecule combining angiotensin receptor blocking agent and neprilysin inhibitor has suggested the hypothesis it would have led to a reduced risk of hospitalization for HF or death from cardiovascular causes among patients with HF and preserved ejection fraction. Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical condition characterized by large pathophysiology heterogeneity with lack of effective therapies as proven by the disappointing results generated by randomized controlled trials.

Paragon trial clinical trial gov