African Americans have a higher burden of
cardiovascular disease than white Americans, including a higher prevalence of
heart failure. In addition,
heart failure in African Americans conforms to a more malignant natural history.
Hypertension is most often cited as the sole etiology of
heart failure in African Americans. Most of the major trials of
pharmacotherapy for the management of chronic
heart failure have failed to include significant numbers of African-American patients. Based on the available evidence, there is no reason to withhold standard evidence-based medical
therapy for
heart failure. Even though there is much controversy as to the efficacy of
angiotensin-converting enzyme (
ACE) inhibitors and beta blockers in African Americans, in the absence of definitive data they should be used. Recently, the combination of
isosorbide dinitrate and
hydralazine has been demonstrated to improve survival in African Americans with New York Heart Association class III and IV
heart failure, and represents an adjunctive treatment option when added to standard medical
therapy consisting of
ACE inhibitors, beta blockers,
digoxin,
diuretics, and
aldosterone antagonists. Emerging evidence suggests that this
therapy may be targeting a novel mechanism of
heart failure progression (ie,
nitric oxide bioavailability) found in African Americans.