Patients were required to
have a plasma B-type natriuretic peptide (BNP)
level of at least 150 pg per milliliter (or an N-terminal
pro-BNP [NT-proBNP] level ≥600 pg per milliliter)
or, if they had been hospitalized for heart
failure within the previous 12 months, a BNP of
at least 100 pg per milliliter (or an NT-proBNP
≥400 pg per milliliter). Patients taking any dose
of an ACE inhibitor or ARB were considered for
participation, but for at least 4 weeks before screening,
patients were required to take a stable dose of
a beta-blocker and an ACE inhibitor (or ARB) equivalent
to at least 10 mg of enalapril daily.23
Exclusion criteria included symptomatic hypotension,
a systolic blood pressure of less than 100 mm Hg at screening or 95 mm Hg at randomization,
an estimated glomerular filtration rate
(eGFR) below 30 ml per minute per 1.73 m2 of
body-surface area at screening or at randomization
or a decrease in the eGFR of more than 25%
(which was amended to 35%) between screening
and randomization, a serum potassium level of
more than 5.2 mmol per liter at screening (or
above 5.4 mmol per liter at randomization), or a
history of angioedema or unacceptable side effects
during receipt of ACE inhibitors or ARBs.
Patients were required tohave a plasma B-type natriuretic peptide (BNP)level of at least 150 pg per milliliter (or an N-terminalpro-BNP [NT-proBNP] level ≥600 pg per milliliter)or, if they had been hospitalized for heartfailure within the previous 12 months, a BNP ofat least 100 pg per milliliter (or an NT-proBNP≥400 pg per milliliter). Patients taking any doseof an ACE inhibitor or ARB were considered forparticipation, but for at least 4 weeks before screening,patients were required to take a stable dose ofa beta-blocker and an ACE inhibitor (or ARB) equivalentto at least 10 mg of enalapril daily.23Exclusion criteria included symptomatic hypotension,a systolic blood pressure of less than 100 mm Hg at screening or 95 mm Hg at randomization,an estimated glomerular filtration rate(eGFR) below 30 ml per minute per 1.73 m2 ofbody-surface area at screening or at randomizationor a decrease in the eGFR of more than 25%(which was amended to 35%) between screeningand randomization, a serum potassium level ofmore than 5.2 mmol per liter at screening (orabove 5.4 mmol per liter at randomization), or ahistory of angioedema or unacceptable side effectsduring receipt of ACE inhibitors or ARBs.
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