ACE and hydrops fetalis: In 2014, the results from the PARADIGM-HF study caused a shift in HF care as it appeared that treatment with the combination of ARB and a neprilysin inhibitor (ARNi, sacubitril-valsartan), instead of the gold standard (the ACE inhibitor enalapril), significantly lowered the composite endpoint cardiovascular (CV) mortality and HF hospitalisation for patients with HFrEF [4].