OBJECTIVES: Black patients have a disproportionately high prevalence of heart failure (HF) and HF-related cardiovascular (CV) death compared to other racial groups. However, the Black population has been vastly under-represented in most randomized clinical trials (RCT) of HF medications. It remains unclear whether HF medications are comparably effective in the Black population vs. the White population. We conducted a meta-analysis of RCT to evaluate the effect of different pharmacological therapies for HF on the Black vs. White population.

METHODS: We included RCT of HF pharmacological therapies with explicit strata of Black or White adults in the primary or secondary analysis. We examined three outcomes: 1) the composite of CV death and hospitalization for heart failure (HHF), 2) HHF, and 3) all-cause mortality. Within each race (White and Black), we calculated the pooled risk ratio (RR) with a 95% confidence interval (CI) of different pharmacological therapies using random-effects models. Within each pharmacological therapy, a meta regression was performed to assess the differences in the treatment effect by race.

RESULTS: In 19 RCT reporting eight pharmacological therapies, there was no significant difference between the Black and White groups for using sacubitril/valsartan, angiotensin-converting enzyme inhibitors, calcium-channel blockers, direct renin inhibitors, oral soluble guanylate cyclase, or vasodilators. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) had a different effect in HHF across the White and Black patients (P_interaction =.030), with a better treatment effect observed in the Black (RR 0.39, 95% CI 0.19 to 0.80) compared to the White group (0.90, 0.71 to 1.14). Beta-blockers had a better treatment effect in the White (0.65, 0.52 to 0.81) compared to the Black group (1.14, 0.88 to 1.47) regarding the all-cause mortality outcome (P_interaction=.001).

CONCLUSIONS: Black individuals with HF appeared to obtain a greater benefit of HHF risk reduction from SGLT2i and less benefit for mortality from beta-blockers compared to their White counterparts.