Journal Club - 2008-05-28

Race and treatment for heart failure.

Beta-blockers and ace-inhibitors:

• Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status: a meta-analysis of major clinical trials.

  J Am Coll Cardiol 2003;41(9):1529-38. PMID: 12742294
  PubMed: Abstract
  Fulltext options: J Am Coll Cardiol website - EBSCO - OVID

  Summary: "Angiotensin-converting enzyme inhibitors and beta-blockers provide life-saving benefits in most of the subpopulations assessed. Women with asymptomatic LV systolic dysfunction may not achieve a mortality benefit when treated with ACE inhibitors."

Isosorbide dinitrate and hydralazine combination:

Key study:

Combination of isosorbide dinitrate and hydralazine in blacks with heart failure.

N Engl J Med 2004;351(20):2049-57. PMID: 15533851
PubMed: Abstract
Fulltext options: N Engl J Med website - CrossRef - EBSCO - OVID

Summary: "The addition of a fixed dose of isosorbide dinitrate plus hydralazine to standard therapy for heart failure including neurohormonal blockers is efficacious and increases survival among black patients with advanced heart failure." Synopsis at ACP J Club. 2005 Mar-Apr;142(2):37 Editorial at N Engl J Med. 2004 Nov 11;351(20):2035-7 Editorial at N Engl J Med. 2004 Nov 11;351(20):2112-4

Background:

1. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure.

N Engl J Med 1991;325(5):303-10. PMID: 2057035
PubMed: Abstract
Fulltext options: EBSCO - OVID

Vasodilator therapy should be included in the standard treatment for heart failure. The different effects of the two regimens (enalapril and hydralazine-isosorbide dinitrate) on mortality and physiologic end points suggest that the profile of effects might be enhanced if the regimens were used in combination. Editorial at N Engl J Med. 1991 Aug 1;325(5):351-3

2. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study.

N Engl J Med 1986;314(24):1547-52. PMID: 3520315
PubMed: Abstract
Fulltext options: EBSCO - OVID

Summary: " Left ventricular ejection fraction (measured sequentially) rose significantly at eight weeks and at one year in the group treated with hydralazine and isosorbide dinitrate but not in the placebo or prazosin groups. Our data suggest that the addition of hydralazine and isosorbide dinitrate to the therapeutic regimen of digoxin and diuretics in patients with chronic congestive heart failure can have a favorable effect on left ventricular function and mortality."