Heart failure is different for African Americans, find out why:

The African American community is at a much higher risk for heart failure (HF) in part because high blood pressure (BP) and diabetes are more common in African Americans than in other ethnic groups. Both of these conditions affect the way your heart works and how blood flows in your body. Some scientists suspect that low levels of nitric oxide, which relaxes blood vessels, may also play a role.1,2

High blood pressure
High BP is the most common cause of HF in African Americans.2 High BP affects African Americans more than any other group. Researchers have also learned that high BP causes more damage to organs, including the kidneys and heart, in African Americans.2

High BP is called a "silent killer" for good reason. Without regular BP checkups, it can go unnoticed, gradually wearing down your heart and blood vessels.3 Taking medicine to lower your BP as needed and adopting some heart-healthy habits can go a long way toward preventing HF in people with high BP.4

A higher rate of diabetes may also be to blame for the higher risk of HF in African Americans. Diabetes has been called an epidemic in the African American community, particularly among women.

Type 2 diabetes (which usually doesn't begin until you're an adult) is the most common form of diabetes. Without proper management, diabetes can damage organs, including the heart, and weaken the heart muscle and the blood vessels around the heart, resulting in HF.5

The nitric oxide connection
Researchers have started to think that some aspects of basic body chemistry may work differently depending on race/ethnicity. This theory, as yet unproven, is based on studies showing that African Americans sometimes respond differently to medicines than people from other ethnic backgrounds.2,6

For example, studies show that African Americans may be more likely to have problems with their blood vessels being able to relax. This narrows the blood vessels and makes it harder for blood to get through. Some researchers suggest this may have something to do with the amount of nitric oxide available in their bodies.1,2 Nitric oxide helps the blood vessels—including the ones in your heart—relax so more blood can flow through. When blood vessels stay narrow, it can interfere with the heart's ability to pump blood as well as it should.7

Other theories about why African Americans' risk for HF is higher include

  • Delays in seeking treatment, limited disease awareness, and treatment adherence issues1
  • More exposure to environmental and other toxins8
  • A greater tendency to be overweight1

The American Heart Association estimates that by 2030, there will be a nearly 30% increase from 2012 in the number of African Americans diagnosed with HF. Overall, nearly 9 million people in the United States are expected to be diagnosed with HF by 2030.9

While anyone can be affected by HF, it hits the African American community the hardest:

  • HF has a more aggressive natural history in African Americans—people are younger and sicker at diagnosis compared with whites7
  • African Americans are 20 times more likely to develop HF before the age of 50 than whites8
  • African Americans are approximately twice as likely to die of HF than whites6
  • African Americans are hospitalized for HF more frequently and at a younger age than whites7
  • African Americans between the ages of 55 and 64 are almost 3X more likely than whites to have a dangerous amount of fluid buildup that can cause severe breathing problems (called a decompensated HF event)10

He always took his dad's advice to heart

Heart failure took that widsom away

Information for Patients about BiDil® (isosorbide dinitrate/hydralazine HCl)

BiDil is approved for use with other heart medicines to treat heart failure in black patients to improve survival, improve heart failure symptoms, and help patients stay out of the hospital longer. There is little experience in patients with heart failure who experience significant symptoms while at rest. Most patients in the clinical study of BiDil also received other heart failure medicines.


Tell your doctor about any allergies you have, especially if you're sensitive to nitrates, such as nitroglycerin tablets or isosorbide dinitrate (Isordil®). BiDil has a nitrate component, so you need to let your doctor know.

Tell your doctor if you're taking any erectile dysfunction or pulmonary hypertension drugs like Viagra® or Revatio(sildenafil), Levitra® (vardenafil) or Cialis® (tadalafil).


Also tell your doctor if you are taking any medication to decrease blood pressure because when taken with BiDil, blood pressure may become too low.

It is possible you'll get headaches, especially at first, but they often lessen over time. Keep your doctor posted on your headache progress; he or she may want to adjust your dosage.

If you experience dizziness, call your doctor. Please make sure to tell your doctor about any of the signs or symptoms mentioned below or about any unusual events that worry you.

Drinking less fluids than your doctor recommends or losing fluid due to diarrhea, sweating, or vomiting may cause low blood pressure, lightheadedness, or fainting. If fainting occurs, stop taking BiDil and contact your doctor immediately.

Lightheadedness may occur when standing, especially after sitting or lying down.

If you experience any achy and/or swollen joints, unexplained fever for more than a few days, skin rashes, chest pain, prolonged weakness or fatigue (even after a good night's sleep), or any other unexplained signs or symptoms, make sure to tell your doctor as they may be signs of a serious medical condition.

You may also experience rapid heartbeat that could lead to chest pain or aggravate chest pain, or numbness or tingling in the hands or feet.


Headache and dizziness were the most frequent side effects experienced in studies with BiDil.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please click here to see full Prescribing Information for BiDil. This information does not take the place of talking with your healthcare provider about your condition or your treatment. Ask your doctor if BiDil may be right for you.

References: 1. Sharma A, Colvin-Adams M, Yancy CW. Heart failure in African Americans: disparities can be overcome. Cleve Clin J Med. 2014;81(5):301-311. 2. Yancy CW. Heart failure in African Americans: unique etiology and pharmacologic treatment responses. J Natl Med Assoc. 2003;95(1):1-9. 3. American Heart Association. What are the symptoms of high blood pressure? https://www.heart.org/HEARTORG/ConditionsHighBloodPressure/SymptomsDiagnosisMonitoringofHighBloodPressure/What-are-the-Symptoms-of-High-Blood-Pressure_UCM_301871_Article.jsp. Updated August 4, 2014. Accessed August 18, 2015. 4. American Heart Association. Heart and artery damage and high blood pressure. www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Heart-and-Artery-Damage-and-High-Blood-Pressure_UCM_301823_Article.jsp. Updated August 4, 2014. Accessed August 18, 2015. 5. National Heart, Lung, and Blood Institute. What causes heart failure? https://www.nhlbi.nih.gov/health/health-topics/topics/hf/causes. Updated March 27, 2014. Accessed August 12, 2015. 6. Yancy CW. Heart failure in African-Americans. US Cardiology. 2006;196-200. 7. Mitchell JE, Ferdinand KC, Watson KE, et al. Treatment of heart failure in African Americans—a call to action. J Natl Med Assoc. 2011;103(2):86-98. 8. Bibbins-Domingo K, Pletcher MJ, Lin F, et al. Racial differences in incident heart failure among young adults. N Engl J Med. 2001;360(12):1179-1190. 9. Heidenreich P, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606-619. 10. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2013;129(3):e28-e292.