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What is BiDil?
Unless you suffer from heart failure (HF), you are unlikely to have heard of BiDil. It is a drug that was specifically designed for African Americans for the treatment of heart failure, by widening the blood vessels and allowing blood to flow much more freely to the heart. It has caused some controversy, due to it being created purely for a specific racial-ethnic group.
A case study of approximately 1,000 African Americans with heart failure gave significant results, in reducing required hospitalisation and deaths. This then gave the go ahead for the drug to be manufactured and provided.
Although the only patients used in the trial were of an African American background, it is widely thought that the drug may also benefit other racial-ethnic groups.
Many scientists and field experts would like to see further trials completed, to include other groups. However, this would be more costly and has yet to be approved.
What is heart failure?
It sounds so final, doesn’t it? However, heart failure does not mean that your heart has stopped working. It actually means that it is not beating as well as it should, due to blood flowing less efficiently and the pressure on your heart increasing to potentially dangerous levels.
This in turn causes the heart to stretch to try and hold more blood, or the muscle may become thicker and stiffer. In any case, your heart becomes weaker and your body then receives less oxygen and nutrients in the blood.
Congestive heart failure is a condition in which you gain a build-up of fluid in other parts of your body, such as your legs or even worse, your lungs. Symptoms include shortness of breath, fatigue, a rapid or irregular heartbeat or a persistent cough.
If you can think back to high school Biology, you will know that your heart is made up of two halves, both of which act like a pump to help blood flow freely through your body. If you suffer from HF, either side can be affected, sometimes both.
However, the most common side to be affected is the left side, known as left-sided HF. This side creates most of the pumping power, so HF really impacts the ability of your heart to fulfil its purpose and keep your blood flowing freely around the body.
If you suffer from right-sided HF, this side of the heart is not as effective at pumping blood to the lungs and therefore not enough oxygen is picked up by the blood and deposited throughout the rest of the body.
Heart failure is very often caused by an underlying illness or disease, leading to heart damage over a period of time. Diabetes and high blood pressure can often lead to HF, especially if not managed correctly with proper medicines and the correct lifestyle changes. Hardening of the arteries and heart attacks can occur, which then lead to a bigger problem of heart failure.
Why are African Americans more at risk?
Unfortunately, statistics show that the African American population is more at risk from congestive heart failure, along with strokes, at a younger age than people from other ethnic groups. This leads to sufferers being hospitalized and often dying younger as a result. Nearly half of all African American adults have a form of cardiovascular disease, which is a pretty frightening statistic.
The amount of hospital care required costs America over $16 billion a year and this cost has increased the need to tackle the problem.
This particular ethnic group has the highest occurrence of high blood pressure, also known as hypertension, in the world. This can cause permanent damage before you even notice any of the symptoms of HF and has therefore earned the frightening nickname of the ‘silent killer’.
Not only is the disease more prevalent in African Americans, but it also tends to occur at a younger age than those of different ethnicities.
So why is this?
Scientific research shows that African Americans may carry a gene that makes them much more sensitive to salt, meaning they are more at risk of high blood pressure and therefore the resulting complications and damage.
Following a low-salt diet can help with this problem and having your blood pressure checked regularly.
Obesity is also a problem that can lead to HF, with the African American population being disproportionately affected. Among this ethnic group, more than 60 percent of men and 75% of women are classed as overweight or even obese.
The advice here is to follow a sensible diet, exercise regularly and limit sugary foods and drinks. Drinking plenty of water will help to stop you snacking as much, as well as helping to flush out your system and cleanse your organs.
Another problem for African Americans is the prevalence of Diabetes Mellitus in comparison to non-Hispanic whites.
It is treatable, even preventable, but recognizing the early warning signs can be a problem with many people. It is advisable to learn what these are and look out for them, speaking to a doctor if you notice any of them.
One other physical explanation is that African Americans may have a much lower nitric oxide bioavailability, which contributes towards the remodelling of the left ventricle. This increases the death rate, as well as other health complications.
Other explanations include a slower diagnosis and treatment of conditions that lead to heart failure, quite possibly due to a limited access to coronary care, as well as behavioural risk factors such as lack of exercise and smoking.
Lower socio-economic status has been blamed for this lack of access to coronary care, with the American health system expecting every citizen should have private medical insurance to gain access to doctors and treatment. This is not always possible for some people and they therefore allow symptoms to worsen before seeking help.
A major problem that has been well documented is the non-adherence to a prescribed diet and medication by the African American population.
It is perhaps due to a lack of education and ongoing support following diagnosis but is nevertheless an issue which can also be put down to a general inability to be able to afford higher quality food and expensive medications.
Many Americans do not realise that there is help available with medication costs and therefore decline taking it for fear of not being able to afford it.
So what exactly is in BiDil?
BiDil is a medication containing both hydralazine and isosorbide dinitrate, which are both drugs that relax and widen the blood vessels. This allows blood to flow easily to the heart and keeps it working as it should. It is used to improve survival rates and to keep patients out of hospital for as long as possible, thus improving the quality of life.
It was developed specifically for the African American population and was only tested on people belonging to this ethnic group. This caused some controversy, as some researchers believe that many sociocultural factors in the causes of disease may be ignored when assuming race is the underlying cause.
However, the introduction of this medication has given much hope and help to African American patients. When tested, the product appeared to give a greater benefit from BiDil than other medicines, designed for use in all ethnic groups.
To further test this theory, approximately 1000 African American patients were tested with the drug. Some had a placebo added to their existing medications and the outcome was that the patients given BiDil had a significantly better result.
It is possible the drug may be tested on patients of other ethnicities in future, to see if they would also benefit in the same way.
How to use BiDil
It is important to note that all patients must only use this medication as directed by their doctor. The medicine comes in tablet form and the most common dosage is three times daily. It is based on the patient’s own medical condition and treatment response, which can vary from patient to patient. It is not a one-time drug and will be taken regularly for maximum benefit.
It is advised that if a patient misses a dose, they should take one as soon as they remember. However, not if it is close to the next dose, as this will lead to an overdose of BiDil. This can lead to symptoms such as severe dizziness, confusion, a throbbing headache or a rapid heartbeat.
Patients should never stop taking the drug suddenly, for this can cause unpleasant symptoms and be dangerous. It is typical for doctors to gradually lower the dosage to wean patients off the medicine instead.
Are there any side effects?
There are various side effects that have been reported but these are not usually anything to worry about. Patients can experience dizziness, nausea and headaches, as well as flushing.
Headaches can occur when the medication is working, so the usual solution is to use a simple pain reliever. It is important that the patient checks with their doctor before mixing any medication. Obviously if headaches become severe or don’t go away, patients should consult their doctor.
In very rare instances, the drug can cause nerve problems. This can be identified by some numbness or tingling and may be combatted by taking a vitamin B6 supplement.
There are more serious side effects that can occur but these are unlikely. They include:
- Aching/swollen joints
- Swollen glands
- Rash on nose and cheeks
- Kidney problems
- Infection (chills, fever, etc)
- Bleeding more easily
- Irregular heartbeat
It is important that patients consult their doctor straight away if they experience any of these side effects, as they should never be ignored and may be a sign that they are reacting badly to the medication.
Patients must seek urgent medical care if they experience pain in their left arm, chest or jaw.
Of course, it is possible that a patient could be allergic to the medication but this has proven rare so far.
Symptoms would include a rash, itching or swelling, trouble breathing and dizziness. As with all medications, it is possible to experience a side effect not yet reported.
If a patient is pregnant, BiDil should only be used if the benefits will outweigh any risk to the foetus.
Clinical studies have not yet produced sufficient evidence to confirm whether or not the drug causes harm to the unborn child, or whether or not it passes into breast milk, so much careful consideration would be needed in these circumstances.
What else should I consider before taking this medicine?
It is advised that you should refrain from drinking alcohol while taking BiDil, for this can cause unwanted side effects. You should also be mindful that it may impair your reactions, so it is advisory to be careful when driving or operating machinery.
So is BiDil safe for me?
Whilst we have already mentioned possible side effects, it is also important to note that there are certain other pre-existing conditions and circumstances to be aware of.
It is not advisable for patients on medication for pulmonary arterial hypertension or erectile dysfunction. Mixed with medication such as Viagra or Levitra, serious and possibly fatal side effects could occur.
A Lupus link
Studies have shown that BiDil can increase the risk of developing a certain type of Lupus, known as Systemic Lupus Erythematosus, which is a debilitating disease more common in black and Asian women. It is a non-contagious autoimmune disease, whereby the body’s immune system attacks its own healthy tissues.
Over 90% of Lupus cases occur in women between the ages of 15 and 45 and with it being three times more likely for black women to contract Lupus, this does pose a greater risk when taking BiDil. Lupus is suffered by one in every 250 African American women, who are already more at risk from developing congestive heart failure.
The general thinking by experts is that the benefits of BiDil far outweigh the risk of contracting Lupus, mainly due to the seriousness of each disease, but it is recommended that patients taking BiDil also have routine blood tests for Lupus.
It is important to note that BiDil should only ever be used in the treatment of heart failure and under the control and guidance of a doctor.