Angiotensin receptor-neprilysin inhibition (ARNI), in the form of sacubitril-valsartan, was compared to enalapril in the Prospective Comparison of (ARNI) with Angiotensin Converting Enzyme Inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial (211). This evidence concerns the gene ACE and hydrops fetalis.