Editorial Comment Impact of Ethnicity and Race on Response to Angiotensin- Converting Enzyme Inhibitors in Heart Failure

Racial and ethnic differences in therapeutic response to pharmacotherapy were raised in the field of heart failure (HF) just over 2 decades ago by the results of the VasodilatoreHeart Failure Trials (V-HeFT) trials. V-HeFT I demonstrated that hydralazine-isosorbide (H-I) therapy resulted in significant reductions in mortality in African Americans compared with placebo, but not in Caucasians. 1 The follow-up study, V-HeFT II, confirmed these results and further demonstrated that angiotensin-converting enzyme inhibitors (ACEIs) were of greater benefit in Caucasians. 2 Based on these results, the African-American Heart Failure Trial (A-HeFT) trial was designed to study the effects on clinical outcomes of the fixed combination of isosorbide dinitrate plus hydralazine versus standard therapy in African-American patients with HF. It demonstrated that isosorbide dinitrate plus hydralazine increased survival and improved symptoms. These results lead to the Food and Drug Administration approval of an HF therapy in a specific racial group. 3 H-I is currently recommended for all African-American patients with New York Heart Association (NYHA) functional class IIIeIV HF in addition to optimal medical therapy and for all patients with HF who are intolerant of ACEI/angiotensin receptor