A drug combination that once transformed outcomes for a specific group of heart failure patients has struggled to prove its worth when the circle of eligibility widens. The H-HeFT trial, presented at the 2026 European Society of Cardiology Congress, found that hydralazine paired with isosorbide dinitrate offered no statistically significant reduction in death or serious heart failure events among a broader, predominantly European population — a sobering counterpoint to the 43 percent mortality reduction it achieved in Black patients two decades prior. Medicine is reminded, once again, that a t