Lesser Response to Angiotensin-Converting–Enzyme Inhibitor Therapy in Black as Compared with White Patients with Left Ventricular Dysfunction
Large-scale trials of therapy for heart failure over the past decade have shown improvements in outcome with angiotensin-converting–enzyme (ACE) inhibitors and beta-blockers. 1 – 7 In the Studies of Left Ventricular Dysfunction (SOLVD), two concurrent trials evaluating the efficacy of enalapril in p...
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| Published in | The New England journal of medicine Vol. 344; no. 18; pp. 1351 - 1357 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
Boston, MA
Massachusetts Medical Society
03.05.2001
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Large-scale trials of therapy for heart failure over the past decade have shown improvements in outcome with angiotensin-converting–enzyme (ACE) inhibitors and beta-blockers.
1
–
7
In the Studies of Left Ventricular Dysfunction (SOLVD), two concurrent trials evaluating the efficacy of enalapril in patients with left ventricular systolic dysfunction, enalapril was associated with a 16 percent reduction in the risk of death from any cause among patients with symptoms
6
and a 20 percent reduction in the risk of death from any cause or hospitalization for heart failure among patients without symptoms.
7
These results and the results of other studies
1
–
5
led to the . . . |
|---|---|
| AbstractList | Background Black patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial differences in the response to drug treatment contribute to differences in outcome is unclear. To address this issue, we pooled and analyzed data from the Studies of Left Ventricular Dysfunction (SOLVD) prevention and treatment trials, two large, randomized trials comparing enalapril with placebo in patients with left ventricular dysfunction. Methods We used a matched-cohort design in which up to four white patients were matched with each black patient according to trial, treatment assignment, sex, left ventricular ejection fraction, and age. A total of 1196 white patients (580 from the prevention trial and 616 from the treatment trial) were matched with 800 black patients (404 from the prevention trial and 396 from the treatment trial). The average duration of follow-up was 35 months in the prevention trial and 33 months in the treatment trial. Results The black patients and the matched white patients had similar demographic and clinical characteristics, but the black patients had higher rates of death from any cause (12.2 vs. 9.7 per 100 person-years) and of hospitalization for heart failure (13.2 vs. 7.7 per 100 person-years). Despite similar doses of drug in the two groups, enalapril therapy, as compared with placebo, was associated with a 44 percent reduction (95 percent confidence interval, 27 to 57 percent) in the risk of hospitalization for heart failure among the white patients (P<0.001) but with no significant reduction among black patients (P=0.74). At one year, enalapril therapy was associated with significant reductions from base line in systolic blood pressure (by a mean [±SD] of 5.0±17.1 mm Hg) and diastolic blood pressure (3.6±10.6 mm Hg) among the white patients, but not among the black patients. No significant change in the risk of death was observed in association with enalapril therapy in either group. Conclusions Enalapril therapy is associated with a significant reduction in the risk of hospitalization for heart failure among white patients with left ventricular dysfunction, but not among similar black patients. This finding underscores the need for additional research on the efficacy of therapies for heart failure in black patients. BACKGROUNDBlack patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial differences in the response to drug treatment contribute to differences in outcome is unclear. To address this issue, we pooled and analyzed data from the Studies of Left Ventricular Dysfunction (SOLVD) prevention and treatment trials, two large, randomized trials comparing enalapril with placebo in patients with left ventricular dysfunction.METHODSWe used a matched-cohort design in which up to four white patients were matched with each black patient according to trial, treatment assignment, sex, left ventricular ejection fraction, and age. A total of 1196 white patients (580 from the prevention trial and 616 from the treatment trial) were matched with 800 black patients (404 from the prevention trial and 396 from the treatment trial). The average duration of follow-up was 35 months in the prevention trial and 33 months in the treatment trial.RESULTSThe black patients and the matched white patients had similar demographic and clinical characteristics, but the black patients had higher rates of death from any cause (12.2 vs. 9.7 per 100 person-years) and of hospitalization for heart failure (13.2 vs. 7.7 per 100 person-years). Despite similar doses of drug in the two groups, enalapril therapy, as compared with placebo, was associated with a 44 percent reduction (95 percent confidence interval, 27 to 57 percent) in the risk of hospitalization for heart failure among the white patients (P<0.001) but with no significant reduction among black patients (P=0.74). At one year, enalapril therapy was associated with significant reductions from base line in systolic blood pressure (by a mean [+/-SD] of 5.0+/-17.1 mm Hg) and diastolic blood pressure (3.6+/-10.6 mm Hg) among the white patients, but not among the black patients. No significant change in the risk of death was observed in association with enalapril therapy in either group.CONCLUSIONSEnalapril therapy is associated with a significant reduction in the risk of hospitalization for heart failure among white patients with left ventricular dysfunction, but not among similar black patients. This finding underscores the need for additional research on the efficacy of therapies for heart failure in black patients. Large-scale trials of therapy for heart failure over the past decade have shown improvements in outcome with angiotensin-converting–enzyme (ACE) inhibitors and beta-blockers. 1 – 7 In the Studies of Left Ventricular Dysfunction (SOLVD), two concurrent trials evaluating the efficacy of enalapril in patients with left ventricular systolic dysfunction, enalapril was associated with a 16 percent reduction in the risk of death from any cause among patients with symptoms 6 and a 20 percent reduction in the risk of death from any cause or hospitalization for heart failure among patients without symptoms. 7 These results and the results of other studies 1 – 5 led to the . . . Black patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial differences in the response to drug treatment contribute to differences in outcome is unclear. To address this issue, we pooled and analyzed data from the Studies of Left Ventricular Dysfunction (SOLVD) prevention and treatment trials, two large, randomized trials comparing enalapril with placebo in patients with left ventricular dysfunction. We used a matched-cohort design in which up to four white patients were matched with each black patient according to trial, treatment assignment, sex, left ventricular ejection fraction, and age. A total of 1196 white patients (580 from the prevention trial and 616 from the treatment trial) were matched with 800 black patients (404 from the prevention trial and 396 from the treatment trial). The average duration of follow-up was 35 months in the prevention trial and 33 months in the treatment trial. The black patients and the matched white patients had similar demographic and clinical characteristics, but the black patients had higher rates of death from any cause (12.2 vs. 9.7 per 100 person-years) and of hospitalization for heart failure (13.2 vs. 7.7 per 100 person-years). Despite similar doses of drug in the two groups, enalapril therapy, as compared with placebo, was associated with a 44 percent reduction (95 percent confidence interval, 27 to 57 percent) in the risk of hospitalization for heart failure among the white patients (P<0.001) but with no significant reduction among black patients (P=0.74). At one year, enalapril therapy was associated with significant reductions from base line in systolic blood pressure (by a mean [+/-SD] of 5.0+/-17.1 mm Hg) and diastolic blood pressure (3.6+/-10.6 mm Hg) among the white patients, but not among the black patients. No significant change in the risk of death was observed in association with enalapril therapy in either group. Enalapril therapy is associated with a significant reduction in the risk of hospitalization for heart failure among white patients with left ventricular dysfunction, but not among similar black patients. This finding underscores the need for additional research on the efficacy of therapies for heart failure in black patients. |
| Author | Domanski, Michael J Dries, Daniel L Cohn, Jay N Exner, Derek V |
| Author_xml | – sequence: 1 givenname: Derek V surname: Exner fullname: Exner, Derek V – sequence: 2 givenname: Daniel L surname: Dries fullname: Dries, Daniel L – sequence: 3 givenname: Michael J surname: Domanski fullname: Domanski, Michael J – sequence: 4 givenname: Jay N surname: Cohn fullname: Cohn, Jay N |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1025879$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/11333991$$D View this record in MEDLINE/PubMed |
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| Keywords | Human Hypertension Heart failure Mortality Negroid Cardiovascular disease Heart ventricle Left ventricular failure Prevention Chemotherapy Randomization Treatment Enalapril Heart disease Race Complication Clinical trial Caucasoid Comparative study |
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| Snippet | Large-scale trials of therapy for heart failure over the past decade have shown improvements in outcome with angiotensin-converting–enzyme (ACE) inhibitors and... Black patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial differences... Background Black patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial... BACKGROUNDBlack patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial... |
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| SubjectTerms | Adult African Continental Ancestry Group Aged Angiotensin-Converting Enzyme Inhibitors - therapeutic use Antihypertensive agents Biological and medical sciences Black people Cardiovascular disease Cardiovascular system Cohort Studies Comparative analysis Drug therapy Enalapril - therapeutic use Enzymes European Continental Ancestry Group Female Heart Failure - drug therapy Heart Failure - ethnology Heart Failure - prevention & control Hospitalization - statistics & numerical data Humans Male Medical sciences Middle Aged Mortality Patients Pharmacology. Drug treatments Randomized Controlled Trials as Topic Stroke Volume Treatment Outcome Ventricular Dysfunction, Left - drug therapy Ventricular Dysfunction, Left - ethnology Ventricular Dysfunction, Left - prevention & control White people |
| Title | Lesser Response to Angiotensin-Converting–Enzyme Inhibitor Therapy in Black as Compared with White Patients with Left Ventricular Dysfunction |
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