Statement of the Problem: Angiotensin-converting enzyme inhibitors (ACEIs) have been associated with a significant reduction in the risk of hospitalization for patients with heart failure. However, in a recent pooled analysis of data from two large ACEI-trials white patients on ACEI therapy had a 40% reduction in the risk of hospitalization (=<.01) compare to patients on placebo, while there was no significant difference for black patients on ACEI and placebo (Exner et al, 2001). These trials have raised the possibility that African American patients with heart failure may not benefit from currently recommended treatments. ACEIs require adequate plasma rennin levels, as well as adequate doses for a benefit to be noted. Thus, the lack of benefit in African American patients could be related to low levels of rennin, inadequate dosing or both. This study will examine the correlation between patient age, rennin levels, ACEI dose levels, and hospital use in African American patients with heart failure.

Specific Aims: The specific aims of this study are to:

1. describe the relationship between renin and ACEI levels in older African Americans treated for CHF;
2. compare renin levels for African American patients aged 50-65 and those over 65 years of age.
3. determine if African American CHF patients with age-related renin suppression are receiving adequate ACEI therapy;
4. explore associations between ACEI dosage levels, renin levels, and acute events in the preceding 6 months controlling for disease severity and comorbidity.

March 2003 Study Update: This project received IRB approval on November 26, 2002. Since November 2002, the MUSC laboratory no longer does on-site analysis of renin levels; an off-site company will be approached to complete the analysis of the patient's renin levels. Recruitment is anticipated to begin in April 2003. Once all of the patients have been recruited, analysis of the data will begin.