Heart Drug Showdown: Perindopril Beats Sacubitril/Valsartan in LVEF Gains

Heart failure with reduced ejection fraction (HFrEF) is a serious condition that affects many people worldwide. It often leads to high death rates, frequent hospital visits, and changes in the heart’s structure. Doctors rely on ACE inhibitors as a core part of treatment. One such drug, perindopril, is long‑acting and generally safe, but there isn’t a lot of clear data on how well it works compared to newer options like sacubitril/valsartan.

Researchers at the Tbilisi Heart Center looked at 214 patients with HFrEF between 2018 and 2025. All participants received guideline‑directed medical therapy (GDMT). They were split into two groups: 118 people took perindopril, while 96 received sacubitril/valsartan. The team measured heart function, echo data, and blood markers at the start, again after 2‑3 weeks, and then after 3‑6 months. The main goals were to see how LVEF and NYHA class changed over time.

Both groups saw improvements in heart function. LVEF rose from about 34% to 41% in the perindopril group, whereas the sacubitril/valsartan group moved from roughly 31% to 34%. The perindopril group also showed larger drops in left‑ventricular end‑diastolic and systolic dimensions and a fall in pulmonary artery pressure. Statistical tests confirmed these changes were significant (p < 0.01). Reverse remodeling happened early, mostly between the first and second check‑ins. In a statistical model, the type of treatment, the starting LVEF, and whether the heart failure was newly diagnosed all predicted the final LVEF values.

The findings suggest that perindopril can be a strong choice for HFrEF patients in routine care. It not only improves ejection fraction but also helps shrink the heart’s chambers and lower pressure in the lungs. While sacubitril/valsartan also offered benefits, the perindopril group achieved a bigger jump in LVEF. These results add useful evidence for clinicians deciding between older ACE inhibitors and newer ARNI therapies.