Sacubitril, used in heart failure with reduced EF, inhibits neprilysin. The combined effect of sacubitril/valsartan results in all of the following EXCEPT:
- A Increased plasma BNP (B-type natriuretic peptide) levels
- B Reduced angiotensin II production ✓
- C Increased plasma bradykinin levels
- D Reduced aldosterone secretion via angiotensin II blockade
Correct answer: B. Reduced angiotensin II production
Explanation
Sacubitril inhibits neprilysin, which degrades natriuretic peptides (ANP, BNP), bradykinin, and substance P — so plasma BNP and bradykinin both increase. Valsartan blocks AT1 receptors, reducing aldosterone secretion and vasoconstriction. However, sacubitril/valsartan does not reduce angiotensin II production (that would require an ACE inhibitor); it blocks angiotensin II's receptor effects, but angiotensin II levels may actually rise due to reactive renin release.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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