What effect does sacubitril have on BNP levels in a patient with heart failure?

Sacubitril is a prodrug that, once activated, inhibits neprilysin, an enzyme responsible for the breakdown of several peptides, including natriuretic peptides like B-type natriuretic peptide (BNP). In heart failure, the levels of BNP are often elevated due to increased myocardial stress and fluid overload. When sacubitril is administered, the inhibition of neprilysin leads to decreased degradation of BNP, therefore resulting in an increased concentration of BNP in the bloodstream.

This increased level of BNP can serve as both a marker of heart failure severity and as a measure of the neurohormonal activation occurring in the patient. The therapeutic action of sacubitril, combined with valsartan (in the combination drug sacubitril/valsartan marketed as Entresto), aims to reduce heart failure progression and hospitalizations, while the increased BNP levels can also reflect the drug's mechanism of action and its impact on heart failure dynamics.

Thus, the correct understanding is that sacubitril increases BNP concentrations due to its inhibition of neprilysin, leading to reduced degradation of this important biomarker.