American Board of Internal Medicine (ABIM) Certification Practice Exam

In what demographic do Hydralazine and isosorbide dinitrate improve symptoms and mortality?

1. Older adults with hypertension

2. Patients with New York Heart Association class III or IV heart failure who are black

3. Men with a history of myocardial infarction

4. Women with diabetes

The correct answer is: Patients with New York Heart Association class III or IV heart failure who are black

Hydralazine and isosorbide dinitrate have been shown to have a beneficial effect on symptoms and mortality specifically in patients with heart failure who are of African American descent, particularly those classified as having New York Heart Association class III or IV heart failure. This evidence is rooted in clinical trials, such as the AHEFT (African American Heart Failure Trial), which demonstrated that this combination therapy significantly improved outcomes in this demographic compared to standard therapies. The rationale behind the effectiveness of hydralazine and isosorbide dinitrate in this population includes their ability to provide vasodilation, which reduces the workload on the heart and improves hemodynamics, leading to enhanced cardiac output and symptom relief in heart failure patients. Additionally, this demographic has been historically underrepresented in clinical trials, making the findings particularly significant as they underscore the need for tailored pharmacological strategies to address disparities in health outcomes. In contrast, the other demographics mentioned do not experience the same level of benefit from this combination therapy. For instance, while older adults with hypertension may benefit from various antihypertensive therapies, the specific combination of hydralazine and isosorbide dinitrate is not uniquely indicated for their situation. Similarly, men with a history of myocardial infar