PARADIGM-HF Trial — EECC MCQ

Correct answer: D — Sacubitril/valsartan reduced cardiovascular death and HF hospitalisation by 20% compared with enalapril, leading to premature trial termination due to overwhelming benefit

PARADIGM-HF (2014) was a landmark double-blind RCT comparing sacubitril/valsartan (97/103 mg bd) with enalapril (10 mg bd) in 8,442 patients with HFrEF (LVEF ≤40%, then ≤35%). It demonstrated a 20% relative risk reduction in the primary composite of cardiovascular death or HF hospitalisation, with significant reductions in both components individually. The trial was stopped early by the DSMB for overwhelming efficacy. All-cause mortality was also significantly reduced. This established sacubitril/valsartan as preferred over ACEi/ARB in HFrEF (Class I, LOE B in 2023 ESC HF Guidelines). Hypotension was more common with sacubitril/valsartan, while cough and hyperkalaemia were more common with enalapril.

Reference: ESC (2023): HF Guidelines; PARADIGM-HF Trial