Related Experiment Videos
Racial differences in incident heart failure during antihypertensive therapy
Peter M Okin1, Sverre E Kjeldsen, Björn Dahlöf
1Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA. pokin@med.cornell.edu
Circulation. Cardiovascular Quality and Outcomes
|February 10, 2011
Summary
Black patients with hypertension have a significantly higher risk of developing heart failure (HF) compared to non-black patients. This increased risk for heart failure persists even after accounting for other risk factors and treatments.
Area of Science:
- Cardiology
- Hypertension Research
- Racial Disparities in Health
Background:
- Black individuals exhibit a higher prevalence of heart failure (HF) compared to non-black individuals, potentially due to a greater burden of HF risk factors like hypertension.
- While HF incidence is notably higher in black individuals during long-term follow-up of young adults, the specific relationship between incident HF and race in treated hypertensive patients remains unclear.
Purpose of the Study:
- To investigate the relationship between race and the incidence of heart failure (HF) in hypertensive patients receiving treatment.
- To determine if the higher incidence of HF in black patients persists after adjusting for various clinical factors and treatments.
Main Methods:
- A cohort of 497 black and 8199 non-black hypertensive patients without a history of HF were analyzed.
- Patients were randomly assigned to losartan- or atenolol-based treatment regimens.
- Cox multivariate analyses were performed, adjusting for treatment, demographics, baseline ECG, HF risk factors, incident myocardial infarction, and time-varying covariates like blood pressure and left ventricular hypertrophy (LVH) indicators.
Main Results:
- Over a mean follow-up of 4.7 years, 265 patients (3.0%) were hospitalized for HF.
- The 5-year incidence of HF was significantly higher in black patients (7.0%) compared to non-black patients (3.1%, P<0.001).
- Black race was independently associated with a 130% increased risk of developing new HF (HR 2.30, 95% CI 1.24-4.28) after comprehensive adjustments.
Conclusions:
- Incident heart failure (HF) is substantially more common in black hypertensive patients than in non-black hypertensive patients.
- The elevated risk of new HF in black individuals is persistent and independent of HF risk factors, treatment effects, in-treatment blood pressure, and ECG markers of left ventricular hypertrophy (LVH).
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
01:22Heart Failure Drugs: β-Blockers
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...
01:30Heart Failure IV: Classification and Diagnostic Evaluation
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
01:27Heart Failure I: Introduction
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
01:30Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
01:22Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.