Hydralazine/Isosorbide Dinitrate Cut Diastolic HF Mortality


ATLANTA — Treatment with hydralazine and isosorbide dinitrate was associated with a mortality benefit in both black and nonblack patients with diastolic heart failure in a large, retrospective, single-center study.

This is an encouraging, albeit nondefinitive, observation, since to date no treatment has been shown effective in decreasing mortality in patients with diastolic heart failure, Dr. Jeremy A. Mazurek noted at the meeting.

Because treatment with hydralazine and isosorbide dinitrate was shown to decrease mortality in black patients with systolic heart failure in the African-American Heart Failure Trial (N. Engl. J. Med. 2004; 351:2049–57), Dr. Mazurek wondered whether it might also be effective in the setting of diastolic heart failure, where there is a huge unmet need for medical therapies. He reviewed the last 10 years' experience with hydralazine/isosorbide dinitrate treatment in patients with diastolic heart failure at Montefiore Medical Center in New York.

The 1-year mortality was 16% in 949 black patients with diastolic heart failure who were treated with the drug compared with 21% in 4,053 who were not.

A significant reduction in mortality was also seen in nonblack patients with diastolic heart failure treated with hydralazine/isosorbide dinitrate, with a 1-year mortality rate of 25% in 634 patients compared with 32% in 5,866 nonblack patients not on the drug.

The limitation of this study is its nonrandomized, retrospective nature. Both black and nonblack diastolic heart failure patients who were placed on hydralazine/isosorbide dinitrate were significantly younger and more likely to be on beta-blocker therapy than were those who were not. On the other hand, they also had a higher prevalence of diabetes, prior MI, and cerebrovascular disease. In any case, these results provide justification for a definitive prospective randomized clinical trial of hydralazine/isosorbide dinitrate in the treatment of diastolic heart failure in patients of all races, according to Dr. Mazurek of Albert Einstein College of Medicine, New York.

He reported having no financial conflicts with regard to this retrospective study, which was conducted free of commercial support.

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