Therapeutic advances in cardiovascular diseaseDec 6, 2024

Guidelines for Using Angiotensin Receptor Neprilysin Inhibitors to Treat Chronic Heart Failure and Other Health Conditions in India

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Mar 19, 2026

Abstract

Multimorbidity affects 43% to 98% of patients and impacts their prognosis and treatment response.

Heart failure management requires a comprehensive approach that includes guideline-directed medical therapy.
, an angiotensin receptor neprilysin inhibitor, is a key treatment supported by large-scale clinical trials.
Recommendations were developed for using ARNI in chronic heart failure patients with comorbid conditions such as type 2 diabetes, chronic kidney disease, myocardial infarction, obesity, and hypertension.
The efficacy of ARNI remains significant regardless of glycemic status in patients with type 2 diabetes.
ARNI may provide benefits for heart failure patients with obesity and those experiencing renal function decline and hyperkalemia.
Considerations for ARNI therapy also include its potential advantages in hypertensive and post-myocardial infarction heart failure patients.

Simplified

(HF) is a significant public health concern characterized by notable rates of morbidity and mortality. Multimorbidity, ranging from 43% to 98% among HF patients, significantly impacts prognosis and treatment response. HF management requires a holistic approach, including guideline-directed medical therapy. (angiotensin receptor neprilysin inhibitor [ARNI]) is a cornerstone of HF treatment, supported by robust evidence from large-scale clinical trials across different levels of left ventricular ejection fraction. The recommendations presented in this paper have been developed by a group of cardiologists in India who convened in expert opinion meetings to discuss the utilization of ARNI in chronic HF patients with five different comorbid conditions like type 2 diabetes mellitus (T2DM), chronic kidney disease, myocardial infarction (MI), obesity, and hypertension. Key focus areas include initiation, dose titration, and management across different HF phenotypes and comorbidities. Emphasis is placed on the efficacy of ARNI irrespective of glycemic status in the T2DM population, its role in HF patients with obesity, and addressing challenges related to renal function decline and hyperkalemia. Additionally, the document highlights ARNI's potential benefits in hypertensive and post-MI HF patients, alongside observations on the obesity paradox in HF prognosis. Overall, these recommendations aim to optimize ARNI therapy in HF patient populations with different comorbidities, addressing specific challenges and considerations to improve outcomes and quality of life.

Key numbers

26%

Increased risk of hospitalization

One-year mortality rose from 13% for patients without comorbidities to 26% for those with five or more comorbidities.

2.3%

utilization rate

Only 2.3% of patients utilized one year after FDA approval.

0.26%

Reduction in NT-proBNP levels

HbA1c concentrations decreased by 0.26% in the group compared to enalapril.

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Guidelines for Using Angiotensin Receptor Neprilysin Inhibitors to Treat Chronic Heart Failure and Other Health Conditions in India

Abstract

Key numbers

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