African Americans (AA) have a higher prevalence of heart failure (HF) when 
compared with White Americans (3% vs 2%), respectively and HF comes on at an 
earlier age and is more severe in AA. The A-HEFT trial with the combination of 
hydralazine and isosorbide dinitrate (ISDNHYD) for self-described AA with NYHA 
class III-IV heart failure with reduced ejection fraction (HFrEF) showed 
reduction in mortality and HF hospitalizations with a class I level of evidence 
A recommendation in the ACC/AHA guidelines. Vericiguat is an oral soluble 
guanylate cyclase stimulator that enhances the cyclic guanosine monophosphate 
(GMP) pathway. A randomized, double-blind, placebo-controlled trial in patients 
with higher risk HFrEF in which AA were underrepresented found that vericiguat 
reduced the composite primary outcome of cardiovascular death or first HF 
hospitalization. In the new era of guideline directed medical therapies of 
quadruple therapy - hydralazine and isosorbide dinitrate should be preferred 
over vericiguat in AA with HFrEF.