- The finding that the rates of renal dysfunction, hyperkalemia, and symptomatic hypotension did not differ significantly between the sacubitrilâ??valsartan group and the enalapril group is reassuring, especially among patients with acute decompensated heart failure, who are at a high risk for hemodynamic instability. - in the sacubitrilâ??valsartan group, there was only one case of angioedema, with no cases among black patients. - Results from previous trials of sacubitrilâ??valsartan, most notably the PARADIGM-HF trial, were limited to ambulatory outpatients who had received established high doses of an ACE inhibitor or ARB, as well as the highest doses of enalapril and sacubitrilâ??valsartan during sequential single-blind run-in periods before randomization. - The PIONEER-HF trial made use of the lowest starting dose of sacubitrilâ??valsartan (24 mg of sacubitril with 26 mg of valsartan), with which there was less experience.