Further data from the PIONEER-HF (Comparison of Sacubitril/Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode) trial demonstrated that sacubitril-valsartan significantly reduced NT-pro-BNP levels and recurrent HFH compared to enalapril, without differences in hypotension, hyperkalemia, or acute kidney injury.8 This evidence concerns the gene NPPB and hydrops fetalis.