Reactive Hyperemia is Decreased in Black Subjects with Heart Failure Despite Equal Prescription of Guideline-Directed Medical Therapy

Abstract

Background Impaired vascular function in Black Americans contributes to a higher risk of heart failure compared to other race/ethnicities. Augmentation of digital pulse volume amplitude (PVA) in response to hyperemia is a novel measure of microvascular function that is partially nitric oxide dependent, and is related to adverse cardiovascular events. We sought to examine augmentation of digital PVA in blacks and whites with heart failure to determine if guideline-directed medical therapy (GDMT) ameliorates racial differences in vascular function. Methods We assessed vascular function in 139 subjects with heart failure with reduced ejection fraction. Using digital pulse amplitude tonometry (EndoPAT), we estimated the reactive hyperemia index (RHI). Generalized linear models were used to determine if race was predictive of the RHI after adjustment for age, sex, blood pressure, diabetes, body mass index, lipid profile, serum creatinine, and number of vasodilator drugs as GDMT. Results Compared with whites, blacks were younger (51 ± 4 vs. 59 ± 11 years, P Figure ). Conclusion Black race is associated with impaired microvascular vasodilatory function, despite equal prescription of GDMT. Whether the vascular impairment seen in Blacks is associated with increased risk for adverse clinical outcomes in HF warrants further investigation.