A RETROSPECTIVE COMPARISON OF ANGIOTENSIN RECEPTOR–NEPRILYSIN INHIBITORS VERSUS ANGIOTENSIN RECEPTOR BLOCKERS IN PATIENTS WITH CARDIOVASCULAR DISEASES

Abstract

Background: Cardiovascular diseases (CVDs), including coronary artery disease (CAD), hypertension (HTN), and heart failure (HF), remain leading causes of morbidity and mortality worldwide. Angiotensin receptor blockers (ARBs) are well-established therapies for these conditions; however, angiotensin receptor–neprilysin inhibitors (ARNIs) have emerged as a promising alternative by providing dual inhibition of the renin–angiotensin–aldosterone system and neprilysin pathway. Although randomized clinical trials have demonstrated the benefits of ARNIs in heart failure, evidence comparing ARNI and ARB therapy across a broader cardiovascular disease population remains limited.
Methods: A retrospective observational study was conducted in the Department of Cardiology at Pushpagiri Medical College Hospital, Thiruvalla. Electronic medical records of 320 eligible patients were reviewed, including 160 patients receiving ARNI therapy and 160 patients receiving ARB therapy. Clinical outcomes, symptom improvement, adverse drug reactions, treatment discontinuation, left ventricular ejection fraction (LVEF), serum creatinine, glycemic control, and systolic blood pressure were assessed. Statistical analyses included Chi-square tests, Mann–Whitney U tests, and Wilcoxon signed-rank tests.
Results: The mean age of participants was 65.3 ± 11.9 years, with males accounting for 62.5% of the study population. CAD was the most common diagnosis (31.3%). Compared with ARB therapy, ARNI therapy was associated with significantly lower rates of rehospitalization (33.8% vs 58.8%, p<0.001), myocardial infarction (6.9% vs 24.4%, p<0.001), syncope (8.8% vs 21.9%, p=0.001), dizziness (13.8% vs 27.5%, p=0.002), gastrointestinal discomfort (8.1% vs 23.1%, p<0.001), and drug discontinuation (9.4% vs 41.9%, p<0.001). Symptom improvement was significantly greater in the ARNI group, particularly for breathlessness, chest pain, edema, and cough. LVEF improvement was observed predominantly among ARNI-treated patients (70.0% vs 11.3%, p<0.001). Both groups achieved significant reductions in systolic blood pressure, although ARNI therapy demonstrated superior blood pressure stability and glycaemic control.
Conclusion: The present study demonstrated that ARNI therapy was associated with better clinical outcomes than ARB therapy in patients with cardiovascular diseases. ARNI-treated patients showed lower rates of rehospitalization and major cardiovascular events, greater symptom improvement, enhanced recovery of left ventricular function, better treatment adherence, and a favorable safety profile.