Editorial commentary on fixed combination isosorbide dinitrate/hydralazine for nitric-oxide-enhancing therapy in...

Systolic heart failure is a condition that exerts a devastating toll on those affected. Therefore, treatments that improve heart failure outcomes incrementally, over and above the currently best available treatments are desperately needed. The fixed-dose combination of isosorbide dintrate-hydralazine provides unambiguous, incremental clinical benefits. However, isosorbide dinitrate/hydralazine has the dubious distinction of being labeled as the first FDA-approved, ethnicity-specific drug. The hypothesis that isosorbide dinitrate/hydralazine provides incremental benefit in non-African-Americans, as proven in the African-American Heart Failure Trial (AHEFT), has not yet been formally tested. Thus, the thesis that the positive AHEFT findings apply only to African-Americans should be rejected, until compelling evidence is available to support this rather implausible notion.