The fixed-dose combination of hydralazine and isosorbide dinitrate demonstrated reduced mortality in a specific subgroup of patients with advanced HFrEF already receiving ACE inhibitors and beta-blockers. This subgroup is:
- A Self-identified Black patients with NYHA class III to IV symptoms ✓
- B Elderly patients above 75 years
- C Patients with concurrent atrial fibrillation
- D Diabetics with left bundle branch block
Correct answer: A. Self-identified Black patients with NYHA class III to IV symptoms
Explanation
The B-HeFT trial showed that adding fixed-dose hydralazine plus isosorbide dinitrate to standard therapy improved survival and reduced hospitalizations in self-identified Black patients with NYHA class III to IV HFrEF, a group with lower nitric oxide bioavailability. This population responds particularly well to the nitric oxide donating strategy. The combination is not indicated as routine add-on therapy outside this subgroup per trial evidence.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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