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Previous Volume 351:2049-2057 November 11, 2004 Number 20 Next

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ABSTRACT

Background We examined whether a fixed dose of both isosorbide dinitrate and hydralazine provides additional benefit in blacks with advanced heart failure, a subgroup previously noted to have a favorable response to this therapy.

Methods A total of 1050 black patients who had New York Heart Association class III or IV heart failure with dilated ventricles were randomly assigned to receive a fixed dose of isosorbide dinitrate plus hydralazine or placebo in addition to standard therapy for heart failure. The primary end point was a composite score made up of weighted values for death from any cause, a first hospitalization for heart failure, and change in the quality of life.

Results The study was terminated early owing to a significantly higher mortality rate in the placebo group than in the group given isosorbide dinitrate plus hydralazine (10.2 percent vs. 6.2 percent, P=0.02). The mean primary composite score was significantly better in the group given isosorbide dinitrate plus hydralazine than in the placebo group (–0.1±1.9 vs. –0.5±2.0, P=0.01; range of possible values, –6 to +2), as were its individual components (43 percent reduction in the rate of death from any cause [hazard ratio, 0.57; P=0.01] 33 percent relative reduction in the rate of first hospitalization for heart failure [16.4 percent vs. 22.4 percent, P=0.001], and an improvement in the quality of life [change in score, –5.6±20.6 vs. –2.7±21.2, with lower scores indicating better quality of life; P=0.02; range of possible values, 0 to 105]).

Conclusions 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.

Source Information

From the University of Minnesota (A.L.T., J.N.C.) and Minneapolis Veterans Affairs Hospital (S.Z.) — both in Minneapolis; University of Texas Southwestern Medical Center, Dallas (C.Y.); Veterans Affairs Medical Center, Washington, D.C. (P.C.); Wake Forest University, School of Medicine, Winston-Salem, N.C. (R.D.); Heartbeats Life Center and Xavier University, New Orleans (K.F.); Jackson Cardiology Associates, Jackson, Miss. (M.T.); Association of Black Cardiologists, Atlanta (M.T.); University of North Carolina, Chapel Hill (K.A.); and NitroMed, Lexington, Mass. (M.S., M.W.).

Address reprint requests to Dr. Anne Taylor at the Department of Medicine/Cardiology, University of Minnesota Medical School, 420 Delaware St. SE, MMC 293, Minneapolis, MN 55455, or at taylo135{at}umn.edu.

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