Abstract 2739: Effect of Angiotensin Converting Enzyme Inhibitor or Beta-Blocker Use on the Benefit of Fixed-Dose Combination of Isosorbide Dinitrate/Hydralazine in the African-American Heart Failure Trial
Introduction: In A-HeFT, fixed-dose combination of isosorbide dinitrate/hydralazine (I/H) therapy for African American (AA) patients with NYHA class III/IV heart failure (HF) on standard therapy improved survival and patient reported functional status and decreased HF hospitalization compared to standard therapy alone (placebo group).
Hypothesis: Some medications in standard HF therapy may not provide additional benefit in I/H treated AA patients with HF.
Methods: Kaplan-Meier survival analyses were used for between I/H and placebo groups and within I/H treated group in 1,050 A-HeFT patients.
Results: Subgroup analysis for event-free survival (death or first HF hospitalization) showed that I/H, compared to placebo, was effective with or without ACE-I or beta-blocker (BB) (Table 1⇓) or other standard medications with all point estimates favoring the I/H group. I/H benefit was also seen with or without ACE-I or BB for all-cause mortality with point estimates favoring the I/H group. Within the placebo-treated group ACE-I or BB were efficacious. However, within the I/H treated group, use of BB but not ACE-I provided additional significant benefit for event-free survival (Table 2⇓) and survival (HR=0.443, p=0.03 for BB use and HR=1.121, p=0.79 for ACE-I use).
Conclusion: Based on the analysis of baseline medications use in A-HeFT, I/H was superior to placebo with or without BB or ACE-I use. However, BB but not ACE-I provided additional benefit to AA with HF treated with I/H. These analyses are hypotheses generating and would need to be investigated in prospective trials.