After the publication of the primary results of PARADIGM-HF (prospective comparison of angiotensin receptor-neprilysin inhibitor with ACE inhibitor to determine impact on global mortality and morbidity in heart failure), a series of subsequent prespecified and post hoc analyses have provided detailed insight into the clinical and quality of life benefits of sacubitril/valsartan compared to enalapril [11,18]. Here, ACE is linked to hydrops fetalis.