{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:01:19Z","timestamp":1773723679679,"version":"3.50.1"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":2497,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2019,3,20]],"date-time":"2019-03-20T00:00:00Z","timestamp":1553040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Creatine Kinase Foundation","award":["17.CKF90.5PH3.22.101"],"award-info":[{"award-number":["17.CKF90.5PH3.22.101"]}]},{"name":"Creatine Kinase Foundation","award":["17.CKF90.5PH3.22.101"],"award-info":[{"award-number":["17.CKF90.5PH3.22.101"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Population data indicate that one in 25 persons of African ancestry has heart failure, a condition with relatively high mortality of around 50% in 5 years. Combined hydralazine and isosorbide dinitrate added to conventional therapy in African ancestry patients with heart failure and reduced ejection fraction improves quality of life and reduces the rate of first hospitalization for heart failure by 33% and annual mortality by 43%. The objectives of this study were to quantify the use of this guideline-recommended therapy in Europe and the potential effect of implementation gaps on mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Prescription drug registration and utilization databases and population statistics were analysed in a cross-European survey without language restriction. Main outcomes were the number of unique patients prescribed the fixed combination hydralazine\u2013isosorbide dinitrate (primary) or both drugs (secondary) in Europe in 2015, and the excess mortality related to prescribing practices was estimated. The survey indicates that around 12 million persons of African ancestry live in Europe. It is estimated that 480 000 persons of this population group have heart failure, with 120 000 eligible for hydralazine and isosorbide dinitrate therapy. However, single-pill hydralazine\u2013isosorbide dinitrate is not authorized and therefore not dispensed in Europe in 2015. Out of the 25 European nations surveyed, the UK and the Netherlands are the only countries with major African ancestry populations where both hydralazine and isosorbide dinitrate are available for oral use, aside Norway, Sweden, and Finland. Hydralazine and isosorbide dinitrate are prescribed to &amp;lt;500 European patients in 2015. Thus, despite the recommendations of the European Society of Cardiology, the large majority of African-European patients with heart failure do not receive this drug combination, potentially resulting in 4800 to 5800 excess deaths yearly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The life-saving, guideline-recommended, adjunctive therapy for heart failure in African ancestry patients with hydralazine and isosorbide dinitrate is rarely used in Europe. This major evidence-practice gap should urgently be overcome to reduce excess mortality in African-European patients with heart failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12421","type":"journal-article","created":{"date-parts":[[2019,3,20]],"date-time":"2019-03-20T06:43:49Z","timestamp":1553064229000},"page":"487-498","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Underuse of Hydralazine and Isosorbide Dinitrate for Heart Failure in Patients of African Ancestry: A Cross-European Survey"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7434-0038","authenticated-orcid":false,"given":"Lizzy M.","family":"Brewster","sequence":"first","affiliation":[{"name":"Creatine Kinase Foundation Amsterdam , PO Box 23639, 1100 EC, Amsterdam ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,3,20]]},"reference":[{"key":"2026012115094687500_ehf212421-bib-0001","volume-title":"Morbidity & Mortality: 2012 Chart Book on Cardiovascular, Lung and Blood Diseases","author":"National Heart, Lung and Blood Institute (NHLBI)"},{"key":"2026012115094687500_ehf212421-bib-0002","doi-asserted-by":"crossref","first-page":"e393","DOI":"10.1161\/CIR.0000000000000534","article-title":"Cardiovascular health in African Americans: a scientific statement from the American Heart Association","volume":"136","author":"Carnethon","year":"2017","journal-title":"Circulation"},{"key":"2026012115094687500_ehf212421-bib-0003","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1056\/NEJMoa0807265","article-title":"Racial differences in incident heart failure among young adults","volume":"360","author":"Bibbins-Domingo","year":"2009","journal-title":"N Engl J Med"},{"key":"2026012115094687500_ehf212421-bib-0004","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s11739-016-1422-x","article-title":"Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity","volume":"11","author":"Brewster","year":"2016","journal-title":"Intern Emerg Med"},{"key":"2026012115094687500_ehf212421-bib-0005","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.amjcard.2014.04.018","article-title":"Use of isosorbide dinitrate and hydralazine in African-Americans with heart failure 9 years after the African-American Heart Failure Trial","volume":"114","author":"Ferdinand","year":"2014","journal-title":"Am J Cardiol"},{"key":"2026012115094687500_ehf212421-bib-0006","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.annepidem.2007.11.013","article-title":"High blood pressure and cardiovascular disease mortality risk among U.S. adults: the third National Health and Nutrition Examination Survey mortality follow-up study","volume":"18","author":"Gu","year":"2008","journal-title":"Ann Epidemiol"},{"key":"2026012115094687500_ehf212421-bib-0007","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jchf.2013.01.003","article-title":"Heart failure with preserved ejection fraction in African Americans: the ARIC (Atherosclerosis Risk in Communities) study","volume":"1","author":"Gupta","year":"2013","journal-title":"JACC Heart Fail"},{"key":"2026012115094687500_ehf212421-bib-0008","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1056\/NEJM200105033441802","article-title":"Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction","volume":"344","author":"Exner","year":"2001","journal-title":"N Engl J Med"},{"key":"2026012115094687500_ehf212421-bib-0009","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/1741-7015-11-141","article-title":"Why do hypertensive patients of African ancestry respond better to calcium blockers and diuretics than to ACE inhibitors and \u03b2-adrenergic blockers? 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