In African American patients with heart failure, which therapy added to standard therapy has shown mortality reduction?

• A. Spironolactone
• B. Digoxin
• C. Nesiritide
• D. Hydralazine–isosorbide dinitrate

Answer: (D)

In African American patients with heart failure, adding a hydralazine–isosorbide dinitrate combination to standard therapy has been shown to reduce mortality. Hydralazine lowers afterload by dilating arteries, while isosorbide dinitrate reduces preload through venodilation; together they improve cardiac output and decrease the work the heart must do. This specific survival benefit was demonstrated in the A-HeFT trial when the combination was added to standard therapy (which typically includes an ACE inhibitor or ARB, beta-blocker, and diuretic). Other agents can improve symptoms or reduce hospitalizations, but this race-specific mortality benefit is unique to the hydralazine–isosorbide dinitrate combo.