The aim of this study was, therefore, to interrogate detailed association of NEP activity with disease progression in pre-HFpEF patients with DM utilising both samples and data from the PARABLE trial [15], whilst undertaking complementary mechanistic studies in experimental DbCM to further understand therapeutic response to Sacubitril/Valsartan as a potential new evidence-based treatment option. Here, MME is linked to diabetes mellitus.