Dries Daniel J, Yancy Clyde W, Strong Mark A, Drazner Mark H
Donald W. Reynolds Cardiovascular Clinical Research Center, Room H8.116, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
Congest Heart Fail. 2004 Jan-Feb;10(1):30-3. doi: 10.1111/j.1527-5299.2004.02022.x.
The treatment of heart failure with angiotensin-converting enzyme inhibitors has resulted in substantial improvements in morbidity and mortality due to heart failure. Varying reports in the literature have suggested that African Americans respond less well to angiotensin-converting enzyme inhibitors, but careful reanalysis of major clinical trials in heart failure, especially the Studies of Left Ventricular Dysfunction (SOLVD), demonstrates a similar mortality benefit for African Americans as for whites. Morbidity, measured as hospitalizations, may not be as favorably impacted. African Americans do respond to angiotensin-converting enzyme inhibitors as a preemptive strategy to prevent heart failure, but the incidence of heart failure is still higher in this population. Mechanisms for these potential nuances in the response to angiotensin-converting enzyme inhibitors are not yet clear. The exaggerated benefit of nitrates and hydralazine implicates alterations in nitric oxide homeostasis. Race is an inadequate model to explain the observed differences. Careful translational research focusing on genetic patterns of disease may help resolve these outstanding questions.
使用血管紧张素转换酶抑制剂治疗心力衰竭已使因心力衰竭导致的发病率和死亡率大幅改善。文献中的各种报告表明，非裔美国人对血管紧张素转换酶抑制剂的反应较差，但对心力衰竭主要临床试验的仔细重新分析，尤其是左心室功能障碍研究（SOLVD），表明非裔美国人与白人在死亡率获益方面相似。以住院率衡量的发病率可能未受到同样有利的影响。非裔美国人确实对血管紧张素转换酶抑制剂作为预防心力衰竭的先发策略有反应，但该人群中心力衰竭的发病率仍然较高。对血管紧张素转换酶抑制剂反应中这些潜在细微差异的机制尚不清楚。硝酸盐和肼屈嗪的显著益处暗示了一氧化氮稳态的改变。种族并不是解释所观察到差异的充分模型。专注于疾病遗传模式的仔细转化研究可能有助于解决这些悬而未决的问题。
