Abstract 17833: Efficacy of Hydralazine and Nitrate Therapy in ACE Intolerant Heart Failure Patients
Background: Hydralazine and nitrate combination has been demonstrated to be an effective add-on therapy in African American heart failure (HF) patients with systolic dysfunction. Similarly, the combination has been suggested as an alternative in HF patients who are ACE inhibitor (ACEinh) intolerant. Few studies have addressed the efficacy of hydralazine and nitrate therapy in real world patients.
Methods: A cohort of 617 patients followed at the Houston VA Medical Center were stratified into 3 treatment groups: Group A: (Intolerant); ACEinh or ARB intolerant, but treated with hydralazine and/or nitrate. Group B: (Neither treatment); not on hydralazine, nitrate or ACEinh. Group C: (Combination therapy); On ACEinh along with hydralazine and/or nitrate.
Results:On multivariate Cox modeling, when compared to Group B (Neither treatment), both Groups A and C were associated with improved outcomes in time-to-hospitalization (HR 0.24; 95% CI 0.152-0.387 and HR 0.14; 95% 0.08-0.23, respectively) and all-cause mortality (HR 0.56; 95% CI 0.37-0.84 and HR 0.62; 95% CI 0.42-0.92, respectively). Group A compared to C, had greater risk of hospitalization (HR 1.74; 95% CI 1.08-2.81), but similar all cause mortality (HR 0.90; 95% CI 0.68-1.2).
Conclusion: In HF patients who are ACE intolerant, using hydralazine and/or nitrate combination therapy is associated with an improvement in both time to hospitalization due to heart failure as well as all cause mortality.
- © 2012 by American Heart Association, Inc.