Treatment of Special Populations


(1) The combination of a fixed dose of isosorbide dinitrate and hydralazine to a standard medical regimen for HF, including ACEIs and beta blockers, is recommended in order to improve outcomes for patients self-described as African Americans, with NYHA functional class III or IV HF. Others may benefit similarly, but this has not yet been tested.

(2) Groups of patients including (a) high-risk ethnic minority groups (e.g., blacks), (b) groups underrepresented in clinical trials, and (c) any groups believed to be underserved should, in the absence of specific evidence to direct otherwise, have clinical screening and therapy in a manner identical to that applied to the broader population.

(3) It is recommended that evidence-based therapy for HF be used in the elderly patient, with individualized consideration of the elderly patient’s altered ability to metabolize or tolerate standard medications.

JACC. 2009; 53; e1-e90