ACE and hydrops fetalis: In patients with HFrEF, sacubitril/valsartan reduced BP and the risk of death and HF hospitalizations; it may also help preserve kidney function.197–199 Modest decreases in triglycerides and increases in HDL-C and LDL-C have been reported.200 Sacubitril/valsartan may increase the risk of hypotension, hyperkalemia, and acute renal failure, and it should not be used with other RAS inhibitors, including ARBs, ACE inhibitors, or aliskiren.