Heart failure in blacks: etiologic and epidemiologic differences

Heart failure in black Americans has become a cardiovascular conundrum of increasing clinical significance. Over 60% of black patients with heart failure have an antecedent history of hypertension as a putative cause of left ventricular (LV) dysfunction, whereas only 30% have coronary artery disease as the suspected cause of LV dysfunction. Once affected with heart failure, the natural history of the disease becomes worrisome: LV dysfunction is more advanced, the severity of the disease is worse, the hospitalization rate is higher, and the mortality rate is at least 30% higher than that of white Americans. When treated in a conventional manner, available data have been inconsistent, and reliable drug efficacy has not been demonstrated. These differences do not appear to be due to socioeconomic factors. It is quite possible that unique pertubations in the neurohormonal environment may explain differences in the natural history of heart failure in blacks and yield new targets of therapy.