Which therapy has demonstrated mortality reduction in African American patients with heart failure when added to standard therapy?

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

Answer: (C)

Hydralazine–isosorbide dinitrate has shown a mortality reduction when added to standard heart failure therapy in African American patients. This key finding comes from the A-HeFT trial, which enrolled black patients with advanced heart failure who were already on optimal therapy and randomized them to receive the hydralazine–isosorbide dinitrate combination versus placebo. The study demonstrated a significant decrease in overall mortality and fewer heart failure hospitalizations with the added regimen.

Mechanistically, hydralazine lowers afterload by arterial dilation, while isosorbide dinitrate causes venodilation and improves nitric oxide availability, which reduces preload and enhances myocardial perfusion. Together, these effects address vascular and myocardial stress in this population, yielding a survival benefit not observed with the other therapies listed in the same way.

Thus, this combination is the option associated with proven mortality reduction specifically in African American patients when added to standard therapies for heart failure.