Title: Is Heart Failure in African Americans a Distinct Entity?
Headings: Is Heart Failure in African Americans a Distinct Entity?
Congestive Heart Failure
Is Heart Failure in African Americans a Distinct Entity?
Abstract and Introduction

Content: In order to answer this question one must consider not only the etiology of heart failure but also the relative response to conventional heart failure therapy and participation in heart failure trials from which the evidence-based data are collated. Although there are multiple etiologies for heart failure, the predominant factor in the United States is coronary artery disease. However, in African Americans the relative prevalence of hypertension as an attributable etiology of heart failure is substantially higher than among Caucasians ( Table 1 ). Also the severity of hypertension as well as associated end-organ damage such as end-stage renal disease, left ventricular hypertrophy, and coronary artery disease is comparatively worse in African Americans than in the general population. [ 3] Many investigators have demonstrated racial differences in the relative efficacy of various antihypertensive agents. [ 4, 5] The renin angiotensin system would appear to play a lesser role in the maintenance of blood pressure in African Americans compared to Caucasians. This fact is partially attributed to lower plasma renin levels as well as more hypervolemia noted in African American hypertensive patients. Blood pressure lowering with angiotensin-converting enzyme (ACE) inhibitors may require higher doses in African Americans, but this should by no means preclude their use for both their renal-protective and endothelial enhancement effects. This is paramount given the results of the Heart Outcomes Prevention Evaluation (HOPE) trial [ 6] in which patients with known vascular disease demonstrated a reduction in cardiac events as well as the development of diabetes when treated with an ACE inhibitor. [ 6]
Many investigators have shown the use of β-adrenergic blocking agents (β blockers) to be less effective anti-hypertensive agents in African Americans than Caucasians. [