RAS Inhibition for Heart Failure with Reduced Ejection Fraction: Are There Racial Differences in Treatment Response?

A meta-analysis of landmark trials finds that outcomes are similar, dispelling a misconception.

Evidence from early pharmacotherapy trials for heart failure with reduced ejection fraction (HFrEF) suggested the possibility that Black individuals may not experience the same benefits from renin-angiotensin system (RAS) inhibition as non-Black individuals. To examine this hypothesis further, researchers conducted a meta-analysis of individual patient–level data from three landmark trials in HFrEF (published between 1991 and 2003) comparing RAS inhibition against placebo in individuals who were not receiving background RAS inhibitor therapy.

Results were as follows:

Overall, rates of death and heart failure hospitalization were higher in Black (n=873) than non-Black (n=7952) individuals.
While the relative risk reduction conferred by RAS inhi…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, MACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)