Monitoring Biomarkers in Patients Receiving Neprilysin Inhibitors

Abstract

To understand the role of neprilysin inhibition in the management of chronic heart failure with reduced ejection fraction (HFrEF) and review effects of neprilysin inhibition on concentrations of natriuretic peptides and other biomarkers. Neprilysin inhibition improves cardiovascular outcomes in patients with chronic HFrEF. As bioactive natriuretic peptides are degraded by neprilysin, treatment with sacubitril/valsartan results in an increase in concentrations of atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). In contrast, neprilysin inhibition led to reduction in concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP). Reduction in NT-proBNP to ≤ 1000 pg/mL with neprilysin inhibition improved cardiovascular outcomes in a recent analysis. Other biomarkers may be affected by neprilysin inhibition. Neprilysin inhibition results in an increase in ANP, BNP, and CNP with corresponding reduction in NT-proBNP concentrations. Other biomarkers may be similarly affected. Given widespread clinical measurement, more data are needed to better understand potential impact on neprilysin inhibition on ability to interpret BNP.