Thread by @DipeshGopal

1/

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THREAD about why race is in the @NICEComms hypertension (blood pressure) guidelines and why it should go: 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: ncbi.nlm.nih.gov/pmc/articles/P…

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: ahajournals.org/doi/full/10.11…

3b/

Interestingly the American blood pressure guidance does not buy this hypothesis is any way: heart.org/en/health-topi…

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: ssom.luc.edu/media/stritchs…

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: journals.sagepub.com/doi/10.1177/10…

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.

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: vox.com/science-and-he…

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Recent genetics have found that there are greater differences between members of the SAME race compared to those of DIFFERENT races:

genetics.org/content/176/1/…

cell.com/ajhg/fulltext/…

8a/

But we know that social factors affect a person's health greater than biological / genetic factors.

nyaspubs.onlinelibrary.wiley.com/doi/abs/10.111…

8b/

Could poverty: journals.lww.com/jhypertension/…

Could stress: ahajournals.org/doi/10.1161/JA…

Could racism: doi.apa.org/doiLanding?doi…

...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: 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. 🙏🏽

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