Echols Melvin R, Yancy Clyde W
University of Texas Southwestern Dallas, TX, USA.
Vasc Health Risk Manag. 2006;2(4):423-31. doi: 10.2147/vhrm.2006.2.4.423.
Despite significant improvement in therapy and management, heart failure remains a worrisome disease state that is especially problematic in special populations. African Americans suffer a disproportionately higher prevalence of heart failure when compared to other populations. It has been recently demonstrated that vasodilator therapy using the combination of isosorbide dinitrate (ISDN) and hydralazine (HYD) as an adjunct to background evidence-based therapy appears to display the strongest signal of benefit in reducing mortality and morbidity in the African American population. Through review of the retrospective and more recent prospective data, we will focus on the benefit of ISDN-HYD as adjunctive therapy for use in African Americans with systolic heart failure on concomitant appropriate evidence based therapy. This review also closely examines some of the potential contributions to endothelial dysfunction in African Americans, and the relationship of vascular homeostasis and nitric oxide. The role of oxidative stress in left ventricular dysfunction will also be explored as a reduction of oxidative stress offers particular promise in the management of heart failure. Although neurohormonal blockade has been responsible for notable event reductions in patients with systolic heart failure, the addition of ISDN-HYD, vasodilator therapy that enhances nitric oxide and reduces oxidative stress, further improves quality of life and survival in African American patients with heart failure. These findings strongly imply that nitric oxide enhancement and/or oxidative stress reduction may be important new therapeutic directions in the management of heart failure.
尽管在治疗和管理方面有了显著改善，但心力衰竭仍然是一种令人担忧的疾病状态，在特殊人群中尤其成问题。与其他人群相比，非裔美国人患心力衰竭的患病率高得不成比例。最近的研究表明，在基于循证治疗的基础上，联合使用硝酸异山梨酯（ISDN）和肼屈嗪（HYD）进行血管扩张剂治疗，似乎在降低非裔美国人的死亡率和发病率方面显示出最强的获益信号。通过回顾回顾性和最新的前瞻性数据，我们将重点关注ISDN-HYD作为辅助治疗对伴有收缩性心力衰竭的非裔美国人在同时进行适当循证治疗时的益处。本综述还仔细研究了非裔美国人内皮功能障碍的一些潜在影响因素，以及血管稳态与一氧化氮的关系。氧化应激在左心室功能障碍中的作用也将被探讨，因为降低氧化应激在心力衰竭管理中具有特别的前景。虽然神经激素阻断已使收缩性心力衰竭患者的显著事件减少，但添加ISDN-HYD这种增强一氧化氮并降低氧化应激的血管扩张剂治疗，可进一步改善非裔美国心力衰竭患者的生活质量和生存率。这些发现强烈暗示，增强一氧化氮和/或降低氧化应激可能是心力衰竭管理中重要的新治疗方向。
