Medical Discussions

In the comments section….

Can you comment on the other endpoints, ie: did the treatment group also have a significant reduction in LV wall thickness or EF that would go along with the proposed mechanism of the drugs in question reducing myocardial hypertrophy and remodeling? second, just to confirm, all these people were still on beta blocker, ace, +/- arb, and even spironolactone, all the while they were on hydral+nitrate, right? kinda expensive and a tough regimen to maintain as an outpatient…

In the study, Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure (NEJM, Nov. 11, 2004), despite listing change in LV ejection fraction and LV wall thickness as secondary endpts at six months, the study does not report these results in the text or any of its tables. 

To be involved in the study patients had to be receiving standard therapy as determined by their physician including beta blockers, ACE inhibitors, diuretics, digoxin, ARBs, and spironolactone.  In fact, an interesting aspect of this trial is that almost 70% of patients in both placebo and experimental arms were on ACE inhibitors and more than 70% of patients were on beta blockers.

To apply the findings of the study, then, pt should be maximized on standard therapy before being started on the combination of isosorbide and hydralizine