ARNI

Question 1

What is an ARNI?

Answer 1

Angiotensin receptor–neprilysin inhibitor (sacubitril/valsartan).

Question 2

Why were ARNIs developed?

Answer 2

To boost beneficial natriuretic peptide activity while blocking harmful angiotensin II effects.

Question 3

What does sacubitril do?

Answer 3

Inhibits neprilysin → ↑ natriuretic peptides → ↑ vasodilation, natriuresis, diuresis.

Question 4

What does valsartan do in the ARNI combination?

Answer 4

Blocks AT1 receptors → ↓ vasoconstriction, ↓ aldosterone, ↓ remodelling.

Question 5

Why can’t sacubitril be used alone?

Answer 5

Neprilysin inhibition alone increases angiotensin II — must be combined with an ARB.

Question 6

What are the key clinical benefits of ARNIs?

Answer 6

Improved symptoms, less hospitalisation, reduced CV mortality, improved survival.

Question 7

Which HF patients should receive ARNIs?

Answer 7

Symptomatic HFrEF patients who are ACEI-intolerant (not angioedema) or remain symptomatic despite optimal therapy.

Question 8

Can ARNIs be used with ACE inhibitors or ARBs?

Answer 8

NO — contraindicated. Must stop ACEI/ARB before starting.

Question 9

How long is the required washout period when switching from ACEI to ARNI?

Answer 9

36 hours.

Question 10

What are the main adverse effects of ARNIs?

Answer 10

Hypotension, hyperkalaemia, renal impairment.

Question 11

Why must ARNIs not be used in patients with past angioedema?

Answer 11

Neprilysin inhibition increases bradykinin — raises angioedema risk.

Question 12

Why are ARNIs considered superior to ACEIs in HFrEF?

Answer 12

They enhance natriuretic peptides AND block RAAS, giving greater reductions in HF hospitalisation and CV mortality.