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The impact of race on response to RAAS inhibition

Thomas W Wallace1, Mark H Drazner

  • 1University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.

Current Heart Failure Reports
|July 23, 2005
PubMed

Insights

Angiotensin-converting enzyme (ACE) inhibitors show varied efficacy in Black and White patients with heart failure. While effective for mortality, ACE inhibitors may be less effective for hospitalizations in Black patients compared to White patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Heart failure with reduced ejection fraction affects diverse populations.
  • Ethnic variations in treatment response for heart failure are increasingly recognized.
  • Angiotensin-converting enzyme (ACE) inhibitors are a standard therapy for heart failure.

Purpose of the Study:

  • To evaluate the efficacy of ACE inhibitors in Black versus White patients with heart failure.
  • To compare the effectiveness of enalapril and isosorbide dinitrate/hydralazine combinations across ethnic groups.

Main Methods:

  • Retrospective analysis of data from the Studies of Left Ventricular Dysfunction (SOLVD) and Vasodilator Heart Failure Trials (V-HeFT).
  • Comparison of mortality, heart failure development, and hospitalization rates based on ethnicity and treatment.

Main Results:

  • In SOLVD, enalapril reduced mortality and heart failure development similarly in Black and White patients, but reduced hospitalizations more in White patients.
  • In V-HeFT II, enalapril reduced mortality more effectively in White patients than isosorbide dinitrate/hydralazine, but not in Black patients.
  • Evidence suggests isosorbide dinitrate/hydralazine may be particularly beneficial for Black patients.

Conclusions:

  • ACE inhibitors remain a crucial therapy for heart failure with reduced ejection fraction in both Black and White patients.
  • Treatment strategies may need ethnic-specific considerations, particularly regarding hospitalization reduction and alternative therapies like isosorbide dinitrate/hydralazine for Black patients.

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