American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common treatment for severe symptomatic heart failure in black patients?

1. Aldosterone antagonists

2. Hydralazine/isosorbide dinitrate

3. Beta blockers

4. Calcium channel blockers

The correct answer is: Hydralazine/isosorbide dinitrate

Hydralazine combined with isosorbide dinitrate is recognized as a recommended treatment specifically for severe symptomatic heart failure in black patients. This combination therapy has been shown to significantly improve outcomes in this population. Clinical studies, such as the A-HeFT trial, demonstrated that this regimen reduced mortality and hospitalizations due to heart failure among black patients, making it a particularly effective option for those who may not respond as well to standard heart failure treatments. The rationale behind this choice lies in the physiological differences and response to medications in different populations. Hydralazine is a direct vasodilator that helps to reduce afterload, while isosorbide dinitrate, a nitrate, reduces preload by dilating veins. Together, they improve hemodynamics and enhance the overall cardiac function in patients experiencing heart failure symptoms. Other treatment options, while beneficial in the general heart failure population, do not specifically target the unique needs or have not shown the same efficacy in the subset of black patients with heart failure. For example, although beta blockers and aldosterone antagonists are cornerstone medications for heart failure management overall, their specific effectiveness and mortality benefit have not been as pronounced in this demographic compared to the hydralazine and isosorbide dinitrate combination.