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1/
THREAD about why race is in the @NICEComms hypertension (blood pressure) guidelines and why it should go: https://www.nice.org.uk/guidance/ng136
@MedCrisis and I read #AngelaSaini's book "Superior" and were horrified at the inclusion of race without clear scientific basis:
#FOAMed
THREAD about why race is in the @NICEComms hypertension (blood pressure) guidelines and why it should go: https://www.nice.org.uk/guidance/ng136
@MedCrisis and I read #AngelaSaini's book "Superior" and were horrified at the inclusion of race without clear scientific basis:
#FOAMed
2/
The @NICEComms specifically implies that Black people are inherently different (assumption: biological/genetic) compared to White people.
Why? @DoctorMayJay
Suggestions: Black people are inherent salt retainers due to salt deficiency, etc: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694537/
The @NICEComms specifically implies that Black people are inherently different (assumption: biological/genetic) compared to White people.
Why? @DoctorMayJay
Suggestions: Black people are inherent salt retainers due to salt deficiency, etc: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694537/
3a/
This article from @American_Heart is a long reach arguing that there are inherent genetic differences between Black people and White people citing small genetic studies: https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.118.11064
This article from @American_Heart is a long reach arguing that there are inherent genetic differences between Black people and White people citing small genetic studies: https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.118.11064
3b/
Interestingly the American blood pressure guidance does not buy this hypothesis is any way: https://www.heart.org/en/health-topics/high-blood-pressure/high-blood-pressure-toolkit-resources
Interestingly the American blood pressure guidance does not buy this hypothesis is any way: https://www.heart.org/en/health-topics/high-blood-pressure/high-blood-pressure-toolkit-resources
4/
But let's look at the evidence:
Meta-analysis comparing blood pressure response to ACE inhibitors for black and white people found a 4mmHg difference: https://ssom.luc.edu/media/stritchschoolofmedicine/publichealthsciences/documents/kc2010.pdf
If Black people were all poor responders, you would expect the difference to be far bigger.
But let's look at the evidence:
Meta-analysis comparing blood pressure response to ACE inhibitors for black and white people found a 4mmHg difference: https://ssom.luc.edu/media/stritchschoolofmedicine/publichealthsciences/documents/kc2010.pdf
If Black people were all poor responders, you would expect the difference to be far bigger.
5/
Conflicting data to show clear benefit/detriment in cardiovascular/cerebrovascular outcomes from ACE inhibitor use for Black people: https://journals.sagepub.com/doi/10.1177/1060028018779082
If they didn't work that well then perhaps there would show no change or clear detriment.
Conflicting data to show clear benefit/detriment in cardiovascular/cerebrovascular outcomes from ACE inhibitor use for Black people: https://journals.sagepub.com/doi/10.1177/1060028018779082
If they didn't work that well then perhaps there would show no change or clear detriment.
6a/
What do you do if you have 1 Black parent and 1 White parent or 1 Black grandparent? Which medication would now be suitable?
Should we use the "1 drop rule"?
Most people can only trace their heritage only a few generations back so can't rule out Black ancestry.
What do you do if you have 1 Black parent and 1 White parent or 1 Black grandparent? Which medication would now be suitable?
Should we use the "1 drop rule"?
Most people can only trace their heritage only a few generations back so can't rule out Black ancestry.
6b/
And no, modern ancestry tests like 23andme, Ancestry DNA look at your genetic make up compared to our people who have also taken the test NOW.
You need a DeLorean to really determine your exact ancestry.
See this article from @voxdotcom: https://www.vox.com/science-and-health/2019/1/28/18194560/ancestry-dna-23-me-myheritage-science-explainer
And no, modern ancestry tests like 23andme, Ancestry DNA look at your genetic make up compared to our people who have also taken the test NOW.
You need a DeLorean to really determine your exact ancestry.
See this article from @voxdotcom: https://www.vox.com/science-and-health/2019/1/28/18194560/ancestry-dna-23-me-myheritage-science-explainer
7/
Recent genetics have found that there are greater differences between members of the SAME race compared to those of DIFFERENT races:
https://www.genetics.org/content/176/1/351 https://www.cell.com/ajhg/fulltext/S0002-9297(14)00355-3
Recent genetics have found that there are greater differences between members of the SAME race compared to those of DIFFERENT races:
https://www.genetics.org/content/176/1/351 https://www.cell.com/ajhg/fulltext/S0002-9297(14)00355-3
8a/
But we know that social factors affect a person's health greater than biological / genetic factors.
https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.1999.tb08123.x
But we know that social factors affect a person's health greater than biological / genetic factors.
https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.1999.tb08123.x
8b/
Could poverty: https://journals.lww.com/jhypertension/Abstract/2015/02000/Socioeconomic_status_and_hypertension__a.4.aspx
Could stress: https://www.ahajournals.org/doi/10.1161/JAHA.119.012139
Could racism: https://doi.apa.org/doiLanding?doi=10.1037%2Fa0033718
...all play a role in why Black people have higher blood pressure than White people?
Could poverty: https://journals.lww.com/jhypertension/Abstract/2015/02000/Socioeconomic_status_and_hypertension__a.4.aspx
Could stress: https://www.ahajournals.org/doi/10.1161/JAHA.119.012139
Could racism: https://doi.apa.org/doiLanding?doi=10.1037%2Fa0033718
...all play a role in why Black people have higher blood pressure than White people?
9/
@MedCrisis and I wrote about this in @JHHypertension here: https://rdcu.be/b61ev
I will be discussing with colleagues and following up with @NICEComms directly.
I've heard @BSHeartFailure have similar concerns so will contact them too.
Opinion piece to follow this too.
@MedCrisis and I wrote about this in @JHHypertension here: https://rdcu.be/b61ev
I will be discussing with colleagues and following up with @NICEComms directly.
I've heard @BSHeartFailure have similar concerns so will contact them too.
Opinion piece to follow this too.
10/
Perhaps ACE inhibitors should be offered to everyone first line considering age?
GPs and (hypertension) experts - thoughts?
@Azeem_Majeed
@BIHSoc_Events
@RichardJMcManus
@RichardLehman1
@mgtmccartney
@trishgreenhalgh
@DrSdeG
@drnealtucker
Thanks.
<< ENDS >>
Perhaps ACE inhibitors should be offered to everyone first line considering age?
GPs and (hypertension) experts - thoughts?
@Azeem_Majeed
@BIHSoc_Events
@RichardJMcManus
@RichardLehman1
@mgtmccartney
@trishgreenhalgh
@DrSdeG
@drnealtucker
Thanks.
<< ENDS >>
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