African American heart failure trial: role of endothelial dysfunction and heart failure in African Americans.

Heart failure (HF) in African Americans may have differences in etiology and drug response. Compared with coronary disease in whites, HF in African Americans is marked by increased prevalence, earlier onset, increased risk for hospitalization and mortality, and increased prevalence of hypertension as the underlying cause of disease. There are apparent differences in pathophysiology and response to cardiac drugs. Endothelial dysfunction is potentially among the hallmarks of HF in this population, with diminished release of nitric oxygen (NO), increased inactivation of NO caused by increased oxidant stress, and impaired antioxidant defenses. Novel approaches to HF in African Americans include the use of isosorbide dinitrate combined with hydralazine in a fixed-dose formulation, which may affect endothelial dysfunction and the relative contribution of NO deficiency in this population. The African American Heart Failure Trial (A-HeFT) demonstrated improvement in morbidity and mortality, including a 39% reduction in hospitalization, improvement in quality of life or functional status, and a 43% reduction in mortality. When added to standard therapy, isosorbide dinitrate and hydralazine provide an evidence-based approach to diminishing morbidity and mortality in this high-risk population.