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Abstract
Background: Heart failure in blacks has been associated with a poorer prognosis than in whites.
In such diseases as hypertension, blacks show pathophysiological differences and respond
differently to some therapies than whites. The aim of this study is to evaluate the
clinical characteristics and response to therapy of black compared with white patients
with heart failure.
Methods and Results: In the first Vasodilator-Heart Failure Trial (V-HeFT I), 180 black male patients
were compared with 450 white male patients for baseline characteristics, prognosis,
and response to therapy. In V-HeFT II, the same comparisons were made for 215 black
and 574 white male patients, including an analysis stratified by the presence or absence
of a history of hypertension. In both trials, black patients had a lower incidence
of coronary artery disease, greater incidence of previous hypertension, and a greater
cardiothoracic ratio (P < .05) than white patients. In V-HeFT II, plasma norepinephrine levels were significantly
less in blacks; plasma renin activity was less only in blacks with a history of hypertension.
Overall mortality or hospitalization for congestive heart failure did not differ between
blacks and whites in the placebo group in V-HeFT I. However, the mortality of black
patients receiving hydralazine plus isosorbide dinitrate (H-I) was reduced (P = .04) in V-HeFT I, whereas white patients showed no difference from placebo. In
V-HeFT II, only white patients showed a mortality reduction from enalapril therapy
compared with H-I therapy (P = .02). Whites also showed evidence of greater blood pressure reduction and enhanced
regression of cardiac size in response to enalapril. When stratified by history of
hypertension in V-HeFT II, only whites with a history of hypertension, who had greater
renin levels, showed significant mortality reduction with enalapril compared with
H-I therapy. Hospitalization rates did not differ between treatment groups in either
study.
Conclusion: Whites and blacks showed differences in cause, neurohormonal stimulation, and pharmacological
response in heart failure. This retrospective analysis suggests angiotensinconverting
enzyme inhibitors are particularly effective in whites, and the H-I combination can
be equally effective in blacks. Prospective trials involving large numbers of black
patients are needed to further clarify their response to therapy.
Keywords
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Article info
Publication history
Accepted:
July 16,
1999
Received in revised form:
July 6,
1999
Received:
June 2,
1999
Footnotes
☆All editorial decisions for this article, including selection of reviewers, were made by a guest editor. This policy applies to all articles with authors from the University of Minnesota.
☆☆Supported by the Veterans Affairs Cooperative Studies Program, Washington, District of Columbia.
Identification
Copyright
© 1999 Published by Elsevier Inc.
