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Angiotensin-converting–enzyme (ACE) inhibitors have been the cornerstone of the treatment for heart failure and a reduced ejection fraction for nearly 25 years, since enalapril was shown to reduce the risk of death in two trials.1,2. The effect of angiotensin-receptor blockers (ARBs) on mortality has been inconsistent,3,4. Combined inhibition of ACE and neprilysin was associated with serious angioedema. In our study we have compared the angiotensin receptor–neprilysin inhibitor (sacubitril- valsartan) with enalapril in patients who had heart failure with a reduced ejection fraction.