The Pharmaceutical Journal
Vol 273 No 7325 p706
13 November 2004

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Combination heart failure therapy effective in black patients

Adding isosorbide dinitrate and hydralazine to conventional therapy for heart failure reduces relative one-year mortality by 43 per cent among black people, a new study has shown (New England Journal of Medicine 2004;351:2049).

The A-HeFT (African-American heart failure trial) was a randomised, double-blind trial in which patients who identified themselves as black received either isosorbide dinitrate plus hydralazine (518 patients) or placebo (532 patients). The trial was halted as a result of the significantly higher mortality rate in the placebo group (10.2 per cent versus 6.2 per cent).

The study followed earlier suggestions that angiotensin-converting enzyme (ACE) inhibitors are less effective in black patients than in white patients. Also, a reanalysis of data comparing isosorbide dinitrate and hydralazine with the ACE inhibitor enalapril showed that the combination therapy did as well as enalapril at prolonging the lives of black patients.

The researchers argue that “the average effects in heterogeneous populations may obscure therapeutic efficacy in some subgroups and lack of efficacy in others”.

In a commentary in the same issue (ibid, p2035), Gregg Bloche, of Johns Hopkins University, Baltimore, Maryland, says that the use of race as a crude marker for genetic variations could act as a stepping stone to finding genetic variations, which could then be used to help develop personalised pharmacotherapy.

However, Dr Bloche argues that although the potential benefits of such research should not be ignored by investigators, they need to be aware of the shortcomings of focusing on race. Such an approach may discourage researchers from exploring all the other social, cultural and environmental aspects that affect physiology.