Y. J. is a 67-year-old African American man with HF who has been treated with lisinopril 20 mg daily, metoprolol succinate 25 mg daily, furosemide 40 mg twice daily, and spironolactone 12.5 mg daily. Despite his current therapy, he still complains of shortness of breath while conducting usual daily activities. What is the most appropriate change that should be made to his regimen?
A. Increase spironolactonec. Initiate isosorbide dinitrate and hydralazine. The ACC/AHA guidelines recommend the initiation of isosorbide dinitrate and hydralazine as a reasonable addition to standard therapy in blacks with New York Heart Association class III/IV HF. The A-HeFT trial evaluated a proprietary drug combination (hydralazine 37.5 mg and isosorbide dinitrate 20 mg per tablet) in African Americans with HF along with standard treatment; because of significant mortality benefit, the study was prematurely discontinued.