Racial differences in response to therapy for heart failure: Analysis of the Vasodilator-Heart Failure Trials

Peter Carson, Susan Ziesche, Gary Johnson, Jay N Cohn

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Background: Heart failure in blacks has been associated with a poorer prognosis than in whites. In such diseases as hypertension, blacks show pathophysiological differences and respond differently to some therapies than whites. The aim of this study is to evaluate the clinical characteristics and response to therapy of black compared with white patients with heart failure. Methods and Results: In the first Vasodilator-Heart Failure Trial (V-HeFT I), 180 black male patients were compared with 450 white male patients for baseline characteristics, prognosis, and response to therapy. In V-HeFT II, the same comparisons were made for 215 black and 574 white male patients, including an analysis stratified by the presence or absence of a history of hypertension. In both trials, black patients had a lower incidence of coronary artery disease, greater incidence of previous hypertension, and a greater cardiothoracic ratio (P < .05) than white patients. In V-HeFT II, plasma norepinephrine levels were significantly less in blacks; plasma renin activity was less only in blacks with a history of hypertension. Overall mortality or hospitalization for congestive heart failure did not differ between blacks and whites in the placebo group in V-HeFT I. However, the mortality of black patients receiving hydralazine plus isosorbide dinitrate (H-I) was reduced (P = .04) in V-HeFT I, whereas white patients showed no difference from placebo. In V-HeFT II, only white patients showed a mortality reduction from enalapril therapy compared with H-I therapy (P = .02). Whites also showed evidence of greater blood pressure reduction and enhanced regression of cardiac size in response to enalapril. When stratified by history of hypertension in V-HeFT II, only whites with a history of hypertension, who had greater renin levels, showed significant mortality reduction with enalapril compared with H-I therapy. Hospitalization rates did not differ between treatment groups in either study. Conclusion: Whites and blacks showed differences in cause, neurohormonal stimulation, and pharmacological response in heart failure. This retrospective analysis suggests angiotensin-converting enzyme inhibitors are particularly effective in whites, and the H-I combination can be equally effective in blacks. Prospective trials involving large numbers of black patients are needed to further clarify their response to therapy.

Original languageEnglish (US)
Pages (from-to)178-187
Number of pages10
JournalJournal of cardiac failure
Issue number3
StatePublished - Sep 1999

Bibliographical note

Funding Information:
All editorial decisions for this article, including selection of reviewers, were made by a guest editor. This policy applies to all articles with authors from the University of Minnesota. Supported by the Veterans Affairs Cooperative Studies Program, Washington, District of Columbia. Manuscript received June 2, 1999; revised manuscript received July 6, 1999; revised manuscript accepted July 16, 1999. Reprint requests: Jay N. Cohn, MD, Cardiovascular Division, University of Minnesota Medical School, Box 508 UMHC, 420 Delaware Street SE, Minneapolis, MN 55455. Copyright © 1999 by Churchill Livingstone ® 1071-9164/99/0503-0001510.00/0

Copyright 2017 Elsevier B.V., All rights reserved.


  • ACE inhibitors
  • Blacks
  • Heart failure
  • Hydralazine-isosorbide dinitrate

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