Latado Adriana Lopes, Lopes Marcelo Barreto, Passos Luiz Carlos Santana, Lopes Antonio Alberto
Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA.
Rev Assoc Med Bras (1992). 2009 Mar-Apr;55(2):110-6. doi: 10.1590/s0104-42302009000200010.
To assess if there is evidence to support different interventions for treatment of heart failure based upon race/ethnicity.
Systematic review of randomized clinical trials permitted comparisons between blacks and whites with systolic heart failure concerning the efficacy of angiotensin converting enzyme (ACE) inhibitors, beta blockers and a combination of hydralazine/ nitrate to reduce the risks of death and hospitalization. The literature search was based on articles published between 1980 and December 2006 cited in MEDLINE or LILACS.
Three studies fulfilled the criteria of the reiew. In SOLVD, enalapril was efficient in reducing the risks of death or hospitalization similarly in whites (relative risk reduction (RRR) =18%) and blacks (RRR=17%). In US Carvedilol, carvediol was also associated with significant reduction in the risk of death or hospitalization both in whites (RRR=49%) and blacks (RRR=43%). In V-HeFT II, enalapril was superior to the combination hydralazine with nitrate in reducing the death risk only in whites.
According to the data ACE inhibitors and beta blockers should be considered as the essential drugs to improve the prognosis of heart failure both in blacks and whites. The A-HeFT study was not included in the review because it was restricted to blacks; however, it should be viewed as evidence that the combination hydralazine/nitrate is beneficial to improve survival in patients with advanced heart failure. Data support development of a clinical trial especially designed to assess if the combination hydralazine/nitrate is also efficient in patients not classified as blacks, with advanced heart failure.
