Evaluation of: Combination of
isosorbide dinitrate and
hydralazine in blacks with
heart failure. Taylor AL, Zieche S, Yancy C et al.: N. Engl. J. Med. 351, 2049-2057 (2004). The African-American
Heart Failure Trial (AHeFT) evaluated the efficacy of a fixed dose combination of
isosorbide dinitrate and hyrdalazine compared with placebo in black patients with advanced self-identified
heart failure. The study was stopped early by the Data Safety Monitoring Board, after a highly significant mortality benefit (43% reduction in all-cause mortality) was seen in the active treatment arm. Similar improvements were seen in other end points, including hospitalizations for
heart failure and quality of life. These data represent a significant advance in the medical management of African-American patients with advanced
systolic heart failure. Additionally, the design of the AHeFT study represents a novel approach to the design of clinical trials in
heart failure, based on an understanding of the mechanism of action of drugs and the underlying pathophysiology of the disease state in specific patients groups. Future research will be required to assess whether benefits of this
drug combination seen in AHeFT can be extended to the wider population of patients with advanced
heart failure.