title: Addition of angiotensin-converting enzyme inhibitors to beta-blockers has a distinct effect on hispanics compared with african americans and whites with heart failure and reduced ejection fraction: a propensity score-matching study.
abstract: BACKGROUND
  There are currently no data on the efficacy of angiotensin-converting enzyme inhibitors (ACEis) in Hispanic patients with heart failure (HF) and reduced ejection fraction (HFrEF). We aimed to investigate the effect of adding ACEis to beta-blockers on mortality and hospitalization for HF exacerbation in patients with HFrEF stratified by race/ethnicity.
  
  
  RESULTS
  From Montefiore Medical Center's 3 large hospitals, 618 consecutive patients with HFrEF (left ventricular ejection fraction [LVEF] <35%) who were on a beta-blocker were retrospectively identified. Patients were divided into 2 groups based on whether or not they were on an ACEi for 24 consecutive months. Propensity score matching including all baseline characteristics was performed and patients were then categorized into 3 groups: African Americans, Hispanics, and Whites/Caucasians. We evaluated 2-year all-cause mortality and 2-year hospitalization for HF exacerbation. Of 618 patients, 66% were categorized as ACEi and 34% as no-ACEi. Four hundred twenty-seven patients were matched 2:1 between the ACEi and no-ACEi groups. After matching, overall 2-year mortality and hospitalization rates were similar between ACEi and no-ACEi (12.4% vs 17.8%, hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.38-1.16; P = .14; and 8.1% vs 9.5%, HR 0.84, 95% CI 0.44-1.60; P = .6; respectively). After stratifying patients based on race/ethnicity, ACEi demonstrated a lower 2-year mortality compared with no-ACEi in Hispanics (9.8% vs 28.4%, HR 0.33, 95% CI 0.13-0.87; P = .018) but not in African Americans (17.0% vs 11.8%, HR 0.94, 95% CI 0.34-2.65; P = .91) or Whites (9.2% vs 10.3%, HR 0.89, 95% CI 0.29-2.74; P = .83). Two-year hospitalization was not different between ACEi and no-ACEi in Hispanics, African Americans, or Whites (all P = NS). In multivariate analysis, ACEi therapy was an independent predictor of lower 2-year mortality (HR 0.33, 95% CI 0.12-0.89; P = .028) in Hispanics only.
  
  
  CONCLUSIONS
  In this retrospective propensity-matched study of patients with HFrEF who were on a beta-blocker, ACEi therapy was associated with greater mortality reduction in Hispanic patients compared with African Americans and Whites. These findings need to be confirmed in large national studies that include a significant fraction of Hispanic patients.
authors: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: Parham
authors: P
authors: Eshtehardi
authors: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: Mohan
authors: M
authors: Pamerla
authors: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: M Khalid
authors: MK
authors: Mojadidi
authors: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: David
authors: D
authors: Goodman-Meza
authors: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: Ninel
authors: N
authors: Hovnanians
authors: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: Anupam
authors: A
authors: Gupta
authors: Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors: Florentino
authors: F
authors: Lupercio
authors: Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors: Jeremy A
authors: JA
authors: Mazurek
authors: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Electronic address: ronald.zolty@einstein.yu.edu.
authors: Ronald
authors: R
authors: Zolty
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D001741:Black or African American; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D016903:Drug Monitoring / Q000379:methods; D004357:Drug Synergism; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D006630:Hispanic or Latino; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000187:drug effects*; D044465:White People
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin-converting enzyme inhibitor; beta-blocker; heart failure; mortality; race and ethnicity