Angiotensin receptor-neprilysin inhibitor in the management of heart failure in patients with an episode of malignant hypertension and advanced kidney dysfunction: A case series and literature review.

Although malignant hypertension (MH) treatment has significantly advanced with the introduction of modern antihypertensive agents, progression to end-stage renal disease remains a significant cause of morbidity and mortality. Additionally, the efficacy of sacubitril/valsartan, which is an angiotensin receptor-neprilysin inhibitor (ARNI), for patients with advanced kidney dysfunction and MH remains unknown. We report the cases of two patients with severe kidney and cardiac dysfunction who received uninterrupted antihypertensive treatment, including sacubitril/valsartan and experienced significant clinical improvement in proteinuria and renal function as well as left ventricular reverse remodeling. This report highlights the benefits of ARNI therapy for MH and its renoprotective effects.