A patient in acute decompensated heart failure is given sacubitril/valsartan. Sacubitril inhibits neprilysin; which endogenous peptides accumulate as a result?
- A Angiotensin II and aldosterone
- B Endothelin-1 and vasopressin
- C Natriuretic peptides (ANP, BNP) and bradykinin ✓
- D Renin and angiotensinogen
Correct answer: C. Natriuretic peptides (ANP, BNP) and bradykinin
Explanation
Neprilysin is a zinc metalloprotease that degrades natriuretic peptides (ANP, BNP, CNP), bradykinin, and other vasoactive peptides. Sacubitril (a prodrug converted to LBQ657) inhibits neprilysin, increasing natriuretic peptide levels—promoting natriuresis, vasodilation, and anti-fibrotic effects. Valsartan (an ARB) is co-administered to block the angiotensin II produced by compensatory renin-angiotensin activation and to prevent the angiotensin-II-mediated bradykinin-related angioedema risk that would occur with ACE inhibitors.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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