The impact of race on response to RAAS inhibition.
Retrospective analyses of the Studies of Left Ventricular Dysfunction (SOLVD) and Vasodilator Heart Failure Trials (V-HeFT) have addressed the question of whether angiotensin-converting enzyme (ACE) inhibitors are equally efficacious in black patients and white patients with heart failure. In SOLVD, there was no ethnic difference in the efficacy of enalapril for reducing mortality and preventing the development of heart failure, but enalapril was more effective in whites in reducing hospitalizations. In V-HeFT II, enalapril was more efficacious than the combination of isosorbide dinitrate and hydralazine in whites in reducing mortality, but not in blacks. However, the combination of isosorbide dinitrate and hydralazine may be particularly advantageous in black patients as suggested by V-HeFT I and the recent African American Heart Failure Trial. In aggregate, the available data suggest that ACE inhibitors should remain a cornerstone of therapy for heart failure with a reduced ejection fraction in white patients and black patients.
Wallace
Thomas W
TW
University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
Drazner
Mark H
MH
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D044383:Black People; D002986:Clinical Trials as Topic; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000208:ethnology*; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D007547:Isosorbide / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000208:ethnology*; D044465:White People; D001741:Black or African American
D000806:Angiotensin-Converting Enzyme Inhibitors; D004234:Diuretics, Osmotic; D014665:Vasodilator Agents; D006830:Hydralazine; D004656:Enalapril; D007547:Isosorbide