Effect of Sacubitril/Valsartan vs Standard Medical Therapies on Plasma NT-proBNP Concentration and Submaximal Exercise Capacity in Patients With Heart Failure and Preserved Ejection Fraction: The PARALLAX Randomized Clinical Trial
RCT (n=2572) found sacubitril/valsartan provided a greater decrease in NT-proBNP at 12 weeks vs individualised comparator (enalapril, valsartan or placebo) among patients with heart failure & left ventricular ejection factor >40% (-0.82 vs -0.98pg/mL, RR 0.84, 95%CI 0.80-0.88).
Source:
Journal of the American Medical Association
SPS commentary:
There was however no significant between-group difference in change from baseline 6-minute walk distance, change in the Kansas City Cardiomyopathy Questionnaire clinical summary score or improvement in NYHA class.
A related commentary notes the findings of this study indicate that sacubitril/valsartan will not provide enough symptom relief to enhance quality of life or improve exercise ability in patients with heart failure with preserved ejection fraction (HFpEF). Thus, the results from this study extend the findings from the PARAGON trial and suggest that patients with HFpEF at low risk of hospitalisation may not derive any benefit from sacubitril/valsartan. Clinicians are eager to provide therapy to the large HFpEF population, and therefore further studies are needed to inform guidance, particularly studies to assess the effect of therapies on symptoms, quality of life, and ability to be active, which are often of the most importance to patients with HFpEF.