ACE and hydrops fetalis: Supporting this assumption, a recent study comparing LCZ696 with the angiotensin converting enzyme inhibitor enalapril in 8399 patients with HF and reduced ejection fraction has shown that levels of plasma BNP were higher during treatment with LCZ696 than with enalapril, but circulating levels of NT-proBNP were lower (P < 0.0001, at 8 months) [48].