Zena and Michael A. Wiener Cardiovascular Institute， Mt. Sinai School of Medicine， New York， New York， USA. 

    BACKGROUND: Hydralazine and isosorbide dinitrate combination (H+ISDN)， angiotensin-converting enzyme inhibitors， and beta-blockers have improved outcomes in heart failure (HF). Analysis of previous trials has shown that H+ISDN appears especially beneficial in African American patients.

    METHODS AND RESULTS: The African-American Heart Failure Trial (A-HeFT) is double-blind， placebo-controlled， and includes African American patients with stable New York Heart Association Class III-IV HF on standard therapy. Patients must have prior HF-related events and left ventricular ejection fraction (LVEF) < or = 35% or LVEF <45% with left ventricular internal diastolic dimension >2.9 cm/m(2). Randomization to addition of placebo or BiDil (Nitro Med， Inc.， Bedford， MA)， a fixed combination of H+ISDN， is stratified for beta-blocker usage. All patients are treated and followed until the last patient entered completes 6 months of follow-up. The primary efficacy endpoint is a composite score including quality of life， death， and hospitalization for HF. At least 600 patients will be randomized; the first was randomized in June 2001. 

    CONCLUSIONS: In addition to providing additional information on BiDil efficacy in HF， A-HeFT is the first HF trial aimed at a selected subgroup of patients and the first to use a new composite HF score as its primary efficacy endpoint