Contemporary treatment of heart failure: is there adequate evidence to support a unique strategy for African-Americans? Pro position.
Clinical trials provide average effects of interventions but are not powered to identify differences in subgroup responses. African-Americans have been under-represented in most previous trials in patients with heart failure. Furthermore, physiologic differences have been demonstrated between African-Americans and whites in the mechanisms and response to therapy in hypertension. Review of previous heart failure trials reveals that African-Americans exhibit less benefit than whites from ACE inhibitors, angiotensin receptor blockers, and at least one b-blocker. In contrast, black patients experienced a greater benefit than white patients from the combination of nitrate and hydralazine. These data emphasize the need for trials in black patients to identify effective therapy. The first such trial, African-American Heart Failure Trial, is currently underway.
Cohn
Jay N
JN
Cardiovascular Division, Mayo Mail Code 508, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA. cohnx001@umn.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001741:Black or African American; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D044383:Black People; D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy* / Q000208:ethnology*; D006801:Humans; D011945:Receptors, Angiotensin / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D011945:Receptors, Angiotensin