Results presented at the 62nd annual ACC meeting showed that although aliskiren, which lowers blood pressure, was expected to improve the prognosis of heart failure, it did not actually benefit. Heart failure is the leading cause of hospitalization in patients over 65 years of age, and with medical costs in the tens of dollars per year, research has really been looking for a more effective means of treatment. ASTRONAUT is an international, double-blind study that enrolled relatively stable patients hospitalized for heart failure and followed up after discharge. Patients were randomized to the aliskiren group (starting at 150 mg and subsequently increasing to 300 mg) and the placebo group. After 6 months of follow-up, there was no difference in the incidence of cardiovascular death and rehospitalization for heart failure between the two groups. However, there was a significant and sustained decrease in plasma NT-BNP in the aliskiren group. In most patients, their plasma BNP correlated with the grading of heart failure and contributed to physician treatment planning. The drugs studied did reduce BNP levels in patients, but did not want to reduce mortality and rehospitalization rates as we expected. In addition to the application of heart failure drugs with evidence-based medical evidence, the addition of aliskiren lowered BNP levels, but hyperkalemia, worsening renal function, and hypotension were significantly increased. It is possible that the side effects of the drug counteracted its beneficial effects. ASTRONAUT enrolled 316 centers with 1,615 hospitalized patients with heart failure discharged on high doses of aliskiren. there were no differences in renal function, ejection fraction, NT-proBNP, hypertension, coronary artery disease, diabetes mellitus, or atrial fibrillation between the two groups at initial baseline. Follow-up was done every two weeks at the beginning, then every three months, and then once a year. Patients did not achieve improvement in their prognosis after discharge, which was the aim of our study. Patients included in the study had a higher mortality rate than outpatients with chronic heart failure, even in those patients who responded well to standard treatment during hospitalization remained so. Previous studies have shown that approximately 30% of patients hospitalized for heart failure are readmitted within 1 to 2 months after discharge. This is mainly because hospitalization is one of the important predictors of death in patients with outpatient heart failure. In patients treated with aliskiren, mortality was lower in patients without diabetes than in those with diabetes. This may be due to the fact that patients with combined diabetes are more likely to develop hyperkalemia, renal impairment, and hypotension. However, the exact mechanism remains to be further analyzed, and he concluded that although the findings in the subgroup are significant, they need to be interpreted with caution due to the statistical limitations of this analysis. Similar findings emerged from ALTITUDE, where the administration of aliskiren increased the incidence of nonfatal stroke in patients with combined diabetes and kidney disease, leading to the early termination of the trial. The ASTRONAUT trial included a completely different population and had different results than the He ALTITUDE trial, and the incidence of stroke was lower in the aliskiren-treated group than in the placebo group. Dr. Gheorghiade suggested that further studies are needed to clarify whether renin inhibitors provide benefit to patients with non-diabetic heart failure.