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Table 3. Percentage of African Americans within study populations and author comments within recent heart failure studies
looking at HFPEF
ACE inhibitors,25 and angiotensin re- did, however, demonstrate a signifi- and 2% of study groups in the
ceptor blockers (ARB)21 have failed to cant difference in secondary outcomes CHARM-study and I-PRESERVE trials
show any survival benefit compared to compared to placebo. The PEP-CHF respectively.21,27 While the SENIORS
placebo in patients with HFPEF. The (Perindopril for Elderly People with trial and the PEP-CHF trial did not
ACC/AHA reviewed the evidence and Chronic Heart Failure) showed that include race in the demographic analysis
produced guidelines stating that the treatment with perindopril significantly at all (Table 3).24,25
treatment of HFPEF should revolve decreased heart failure hospitalization, Even though there is no evidence
around the control of hypertension, improved NYHA classification, and the specifically in HFPEF, inferences may
control of ventricular rate in patients 6-minute corridor walk distance at 1- be drawn from RCTs involving HFREF
with atrial fibrillation, the use of year follow-up.25 The CHARM-Pre- and African American populations. It is
diuretics to control pulmonary conges- served study also demonstrated signifi- well-documented that African American
tion and peripheral edema and coronary cant reduction in HF admissions at one populations differ in their response to
revascularization in patients with coro- year.21 African American populations various medical therapies in HFREF.
nary heart disease in whom ischemia is were largely under-represented in all of Exner et al demonstrated that enalapril
judged to have an adverse effect on the major RCTs looking at pharmaco- therapy is associated with a significant
diastolic function.26 Some of these trials therapy in HFPEF, making up only 4% reduction in the risk of hospitalization
rates have varied between studies, with follow-up. Clin Exp Hypertens. 1995;17(7): of a normal left ventricular ejection fraction:
some indicating no mortality difference 1091–1105. results of the New York Heart Failure Registry.
6. Vasan RS. Diastolic heart failure. BMJ. J Am Coll Cardiol. 2004;43(8):1432–1438.
and others showing up to 34% worse 19. Bhatia RS, Tu JV, Lee DS, et al. Outcome of
2003;327(7425):1181–1182.
mortality in African Americans without 7. Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure with preserved ejection fraction
coronary artery disease compared to heart failure–abnormalities in active relaxation in a population-based study. N Engl J Med.
Caucasians. The propensity for African and passive stiffness of the left ventricle. 2006;355(3):260–269.
American populations to have greater N Engl J Med. 2004;350(19):1953–1959. 20. Lee DS, Gona P, Vasan RS, et al. Relation of
8. Paulus WJ, Tschope C, Sanderson JE, et al. How disease pathogenesis and risk factors to heart
left ventricular hypertrophy, diastolic
to diagnose diastolic heart failure: A consensus failure with preserved or reduced ejection
dysfunction, worse renal function are statement on the diagnosis of heart failure with fraction: Insights from the Framingham Heart
the most likely contributing factors to normal left ventricular ejection fraction by the Study of the National Heart, Lung, and Blood
younger age of onset and greater Heart Failure and Echocardiography Associa- Institute. Circulation. 2009;119(24):3070–
mortality. Indeed, left ventricular hy- tions of the European Society of Cardiology. Eur 3077.
pertrophy in itself has been shown to Heart J. 2007;28(20):2539–2550. 21. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects
9. Rittoo D, Monaghan M, Sadiq T, Nichols A, of candesartan in patients with chronic heart
be an independent risk factor for
Richardson PJ. Echocardiographic and dopp- failure and preserved left-ventricular ejection
death.17 Mechanisms including a ge- ler evaluation of left ventricular hypertrophy fraction: The CHARM-preserved trial. Lancet.
netic predisposition and increased med- and diastolic function in Black and White 2003;362(9386):777–781.
ication resistance may play a role in the hypertensive patients. J Hum Hypertens. 22. Somaratne JB, Berry C, McMurray JJ, Poppe
different outcomes in HFPEF. Howev- 1990;4(2):113–115. KK, Doughty RN, Whalley GA. The prognostic
er, many still believe that prognosis in 10. Kizer JR, Arnett DK, Bella JN, et al. significance of heart failure with preserved left
Differences in left ventricular structure be- ventricular ejection fraction: A literature-based
HFPEF is primarily due to disparity in tween Black and White hypertensive adults: meta-analysis. Eur J Heart Fail. 2009;11(9):
health care access. As such, dedicated The hypertension genetic epidemiology net- 855–862.
prospective studies and RCTs like the work study. Hypertension. 2004;43(6):1182– 23. Smith GL, Masoudi FA, Vaccarino V, Radford
A-HeFT trial, which look primarily at 1188. MJ, Krumholz HM. Outcomes in heart failure
African Americans, need to be con- 11. Alexander M, Grumbach K, Remy L, Rowell patients with preserved ejection fraction:
R, Massie BM. Congestive heart failure Mortality, readmission, and functional decline.
ducted to provide further insight and
hospitalizations and survival in California: J Am Coll Cardiol. 2003;41(9):1510–1518.
allow race specific treatment guidelines patterns according to race/ethnicity. Am 24. Flather MD, Shibata MC, Coats AJ, et al.
to be created. Heart J. 1999;137(5):919–927. Randomized trial to determine the effect of
12. Stein CM, Lang CC, Singh I, He HB, Wood nebivolol on mortality and cardiovascular
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