By increasing the NP levels and stimulating the cyclic guanosine monophosphate/ protein kinase G (cGMP/PKG) pathway, sacubitrilat (Sac; the active metabolite of sacubitril) may improve cardiomyocyte function in (early) cardiac remodeling, as reported for ANP in a murine model of HF (8). This evidence concerns the gene NPPA and hydrops fetalis.