Similar to the PARADIGM-HF trial, a prospective comparative study of ARNI and enalapril in Japanese patients with HFrEF (the prospective comparison of ARNI with ACE inhibitor to determine the novel beneficial therapeutic value in Japanese HF patients [PARALLEL-HF] trial) demonstrated that ARNI was safe and well tolerated in Japanese patients with CHF (2), (3). This evidence concerns the gene ACE and hydrops fetalis.