title: Angiotensin converting enzyme inhibitors and beta-blockers in African Americans with heart failure.
abstract: Previous analyses have implied diminished efficacy of angiotensin converting enzyme inhibitors (ACEI), and equivalent or enhanced efficacy of beta-blockers (BB), in African Americans (AA) with congestive heart failure (CHF), when compared to placebo. These results may have been influenced by lead-time bias, in that AA may not have been entered into the older ACEI trials until late in their CHF course. Our goal was to use a prospective cohort study of 29,686 CHF patients within a single health system to examine the impact on AA mortality of administering ACEI and BB within the first year of CHF diagnosis. Pharmacy claims from 1995-1998 were available for 3353 newly diagnosed CHF patients (39.2% AA; N=1317) within the health maintenance organization. Rates of ACEI and BB use were 46.4% and 54.0%; 43.4% and 28.9%; and 40.7% and 18.6%, for Whites, AA, and other races, respectively. The relative risk reductions (RRR) for ACEI were 68.7%, P<.0001; 52.1%, P<.0001; and -36.3%, P=.56, for Whites, AA, and other races, respectively. The RRR for BB were 59.0%, P<.0001; 34.6%, P=.009; and 74.3%, P=.17, for Whites, AA, and other races, respectively. Age- and gender-adjusted survival rates for AA were significantly enhanced in those taking ACEI, BB, or a combination of the two: P<.001, P=.001, and P=.003, respectively. Although we could not control for selection bias, these data suggest that AA benefit from both ACEI and BB when treatment is initiated within the first year of CHF diagnosis. Future, similar analyses other databases should control for the duration of illness to avoid lead-time bias in AA with CHF.
authors.affiliation: Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Beaumont Health Center, Royal Oak, MI 48073, USA. pmc975@yahoo.com
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Edward F
authors.initials: EF
authors.lastname: Philbin
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Keisha R
authors.initials: KR
authors.lastname: Sandberg
authors.forename: Scott
authors.initials: S
authors.lastname: Kaatz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006279:Health Maintenance Organizations; D006333:Heart Failure / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D016019:Survival Analysis
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors