What is BiDil and why does it matter for Black men with heart failure?

BiDil is a combination of isosorbide dinitrate and hydralazine, FDA-approved in 2005 specifically for Black patients with heart failure. The African American Heart Failure Trial (A-HeFT) demonstrated a 43% reduction in mortality in Black patients with heart failure with reduced ejection fraction who received BiDil added to standard heart failure therapy. The trial was stopped early due to overwhelming benefit, a result that parallels the JUPITER and SELECT findings in magnitude and significance.

The mechanism is particularly relevant to Black cardiovascular physiology: Black patients with heart failure have demonstrated reduced bioavailability of nitric oxide, and the isosorbide dinitrate/hydralazine combination restores NO signaling in the failing myocardium. Dr. Clyde Yancy at Northwestern, the foremost authority on heart failure in African Americans, has consistently documented that BiDil is underused relative to its evidence base, a pattern consistent with the broader under-treatment of Black patients in cardiovascular medicine. The drug works in the population that was studied. Men in that population who have heart failure and are not on BiDil, or who have never had the conversation with their cardiologist about whether they are candidates, are not receiving guideline-concordant care. (A-HeFT, referenced by Yancy, JAMA 2024)

Cardiologist's calibrated position, Promising (2) for BiDil (acknowledging that the A-HeFT trial enrolled only Black patients, which limits direct comparative evidence against placebo in non-Black populations). Solid (1) for the A-HeFT mortality reduction finding in the trial population.

What to do: If you are a Black man with heart failure with reduced ejection fraction and are not on isosorbide dinitrate/hydralazine, ask your cardiologist specifically about BiDil and the A-HeFT findings.

For the full picture, read The Cardiac Inheritance.