In patients with heart failure with preserved ejection fraction (HFpEF), sacubitril/valsartan provides significantly greater reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) than optimal individualized medical therapy, while improvements in functional capacity are similar between the two groups, results of the PARALLAX trial have shown.

The trial’s first primary endpoint of change in plasma NT-proBNP from baseline to 12 weeks was 16.4 percent greater in patients randomized to receive sacubitril/valsartan vs optimal individualized medical therapy (enalapril, valsartan, or placebo for patients not on a renin-angiotensin system [RAS] inhibitor) (p<0.0001). [Pieske B, et al, ESC 2020]

However, the second primary endpoint of change in 6-minute walk distance from baseline to 24 weeks did not differ significantly between the two groups (mean difference, -2.5 m; p=0.79).

Rates of serious adverse events were similar between the two groups except for HF events, which were more common with individualized medical therapy. In a post hoc analysis, sacubitril/valsartan significantly reduced the risk of HF hospitalization by 50 percent (p=0.005) vs individualized medical therapy. Patients in the sacubitril/valsartan group also had a significantly lower decline in renal function at 24 weeks.