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Role of race in the pharmacotherapy of heart failure

James S Kalus1, Jean M Nappi

  • 1Medical University of South Carolina, Charleston, USA. james.kalus@excite.com

The Annals of Pharmacotherapy
|March 16, 2002
PubMed

Insights

Black patients may not benefit from angiotensin-converting enzyme (ACE) inhibitors or beta-blockers for systolic heart failure. More research is needed to confirm racial differences in treatment response.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Disparities

Background:

  • Systolic heart failure management often involves angiotensin-converting enzyme (ACE) inhibitors and beta-blockers.
  • Observed differences in drug response across racial groups necessitate investigation.

Purpose of the Study:

  • To review existing literature on the differential response to ACE inhibitors and beta-blockers in Black versus non-Black patients with systolic heart failure.

Main Methods:

  • A comprehensive MEDLINE search was conducted for relevant English-language articles published between January 1966 and May 2001.
  • Keywords included heart failure, Black patients, beta-blockers, and ACE inhibitors.
  • References from identified articles were also reviewed to ensure comprehensive data inclusion.

Main Results:

  • Some evidence suggests a potentially diminished antihypertensive effect of ACE inhibitors and beta-blockers in Black patients.
  • Retrospective analyses indicate Black patients may not experience significant morbidity or mortality benefits from these agents in heart failure.
  • Conversely, Black patients might respond more favorably to hydralazine and isosorbide dinitrate combination therapy.

Conclusions:

  • Current data from reanalyses of trials are limited and provide weak support for a lack of benefit of ACE inhibitors and beta-blockers in Black patients.
  • The retrospective nature of existing studies restricts definitive conclusions.
  • Prospective trials with planned race-based analyses are essential to establish the influence of race on the effectiveness of these heart failure medications.
Abstract

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