Which drug combination is recommended to improve mortality in Black patients with heart failure?

• A. ACE inhibitors with diuretics
• B. Isosorbide dinitrate and hydralazine
• C. Beta blockers alone
• D. Calcium channel blockers

Answer: (B)

This item tests recognition of a therapy shown to reduce mortality specifically in Black patients with heart failure. Adding a combination of isosorbide dinitrate and hydralazine to standard heart failure treatment has been demonstrated to improve survival in this population.

Isosorbide dinitrate donates nitric oxide, leading to venodilation that lowers preload, while hydralazine causes arterial dilation that lowers afterload. Together, they improve cardiac output and reduce the strain on the failing heart. In the influential trial focused on Black patients with systolic heart failure already on optimal standard therapy, this combo reduced mortality and improved outcomes compared with standard therapy alone. Because of that evidence, guidelines endorse this combination for Black patients with heart failure who remain symptomatic despite standard treatment.

In practical terms, this regimen is added to ongoing ACE inhibitor/ARB therapy, beta blockers, and diuretics, with attention to potential side effects like headache or low blood pressure.