Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias
The renin-angiotensin-aldosterone system (RAAS) plays a major role in cardiovascular health and disease. Short-term RAAS activation controls water and salt retention and causes vasoconstriction, which are beneficial for maintaining cardiac output in low blood pressure and early stage heart failure....
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doaj-e2f88281682b45f9a36f0e4c1008be532021-08-26T13:53:33ZengMDPI AGInternational Journal of Molecular Sciences1661-65961422-00672021-08-01228994899410.3390/ijms22168994Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac ArrhythmiasHenry Sutanto0Dobromir Dobrev1Jordi Heijman2Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The NetherlandsWest German Heart and Vascular Center, Institute of Pharmacology, University Duisburg-Essen, 45147 Essen, GermanyDepartment of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The NetherlandsThe renin-angiotensin-aldosterone system (RAAS) plays a major role in cardiovascular health and disease. Short-term RAAS activation controls water and salt retention and causes vasoconstriction, which are beneficial for maintaining cardiac output in low blood pressure and early stage heart failure. However, prolonged RAAS activation is detrimental, leading to structural remodeling and cardiac dysfunction. Natriuretic peptides (NPs) are activated to counterbalance the effect of RAAS and sympathetic nervous system by facilitating water and salt excretion and causing vasodilation. Neprilysin is a major NP-degrading enzyme that degrades multiple vaso-modulatory substances. Although the inhibition of neprilysin alone is not sufficient to counterbalance RAAS activation in cardiovascular diseases (e.g., hypertension and heart failure), a combination of angiotensin receptor blocker and neprilysin inhibitor (ARNI) was highly effective in several clinical trials and may modulate the risk of atrial and ventricular arrhythmias. This review summarizes the possible link between ARNI and cardiac arrhythmias and discusses potential underlying mechanisms, providing novel insights about the therapeutic role and safety profile of ARNI in the cardiovascular system.https://www.mdpi.com/1422-0067/22/16/8994neprilysinrenin-angiotensin-aldosteronearrhythmiacardiovascularpharmacologyheart rhythm |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Henry Sutanto Dobromir Dobrev Jordi Heijman |
spellingShingle |
Henry Sutanto Dobromir Dobrev Jordi Heijman Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias International Journal of Molecular Sciences neprilysin renin-angiotensin-aldosterone arrhythmia cardiovascular pharmacology heart rhythm |
author_facet |
Henry Sutanto Dobromir Dobrev Jordi Heijman |
author_sort |
Henry Sutanto |
title |
Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias |
title_short |
Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias |
title_full |
Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias |
title_fullStr |
Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias |
title_full_unstemmed |
Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias |
title_sort |
angiotensin receptor-neprilysin inhibitor (arni) and cardiac arrhythmias |
publisher |
MDPI AG |
series |
International Journal of Molecular Sciences |
issn |
1661-6596 1422-0067 |
publishDate |
2021-08-01 |
description |
The renin-angiotensin-aldosterone system (RAAS) plays a major role in cardiovascular health and disease. Short-term RAAS activation controls water and salt retention and causes vasoconstriction, which are beneficial for maintaining cardiac output in low blood pressure and early stage heart failure. However, prolonged RAAS activation is detrimental, leading to structural remodeling and cardiac dysfunction. Natriuretic peptides (NPs) are activated to counterbalance the effect of RAAS and sympathetic nervous system by facilitating water and salt excretion and causing vasodilation. Neprilysin is a major NP-degrading enzyme that degrades multiple vaso-modulatory substances. Although the inhibition of neprilysin alone is not sufficient to counterbalance RAAS activation in cardiovascular diseases (e.g., hypertension and heart failure), a combination of angiotensin receptor blocker and neprilysin inhibitor (ARNI) was highly effective in several clinical trials and may modulate the risk of atrial and ventricular arrhythmias. This review summarizes the possible link between ARNI and cardiac arrhythmias and discusses potential underlying mechanisms, providing novel insights about the therapeutic role and safety profile of ARNI in the cardiovascular system. |
topic |
neprilysin renin-angiotensin-aldosterone arrhythmia cardiovascular pharmacology heart rhythm |
url |
https://www.mdpi.com/1422-0067/22/16/8994 |
work_keys_str_mv |
AT henrysutanto angiotensinreceptorneprilysininhibitorarniandcardiacarrhythmias AT dobromirdobrev angiotensinreceptorneprilysininhibitorarniandcardiacarrhythmias AT jordiheijman angiotensinreceptorneprilysininhibitorarniandcardiacarrhythmias |
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1721192535086333952 |