The prevention of heart failure in minority communities and discrepancies in health care delivery systems

The modification of known risk factors that are over-represented in the minority community and the effective treatment of hypertension represent major opportunities to reduce the disproportionate cardiovascular morbidity and mortality experienced by this patient population and, possibly, to prevent HF. Hypertension and HF can be treated effectively in the minority community with a regimen of agents not dissimilar from that used for the general population. There is no reason to vary from evidence-based recommendations in the treatment of African Americans with hypertension or HF. Subtle differences in the mechanisms of disease, drug metabolism, and the responsiveness to therapy do exist, but these differences are not sufficient to withhold treatment strategies with known salutary benefit on important clinical outcomes for these diseases. The plethora of clinical trial data that now demonstrate our ability to improve the natural history of hypertension and HF should serve the entire population. Treatment regimens should be individualized based on the disease presentation, associated comorbidity, and disease severity and not on something as arbitrary as race.