Race-Based Therapeutics

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Abstract
Are we moving into a new era of race-based therapeutics? The publication, in this issue of the Journal, of the African-American Heart Failure Trial (A-HeFT) (pages 2049–2057), a clinical trial of a medication intended for a single racial group, poses this awkward question. The study's most striking finding — that the addition of isosorbide dinitrate and hydralazine to conventional therapy for heart failure reduced relative one-year mortality by 43 percent among blacks — will provoke wide discussion. The trial's sponsor, NitroMed, which holds a patent on the fixed-dose combination of isosorbide dinitrate and hydralazine that was used, posits that heart failure has a different pathophysiology in blacks than in whites, necessitating different treatment strategies.1