@RaoMala @GraceOkoli and I write in @JHHypertension: nature.com/articles/s4137…
🧵 THREAD on why we need to seriously re-consider race in the @NICEComms hypertension guidance:
1️⃣ There is a small difference in ACE inhibitor blood pressure response between Afro-Caribbean and White people.
bmcnephrol.biomedcentral.com/articles/10.11…
bmj.com/content/371/bm…
2️⃣ Stereotyping all Afro-Caribbean people as being low renin responders is not based in science:
nature.com/articles/10011…
3️⃣ No one can tell if they do/not have Afro-Caribbean ancestry, so who decides if they should have a treatment over the other?
academic.oup.com/genetics/artic…
cell.com/ajhg/fulltext/…
onlinelibrary.wiley.com/doi/10.1111/14…
4️⃣ Why is race important at the beginning of the guidance but not after initial treatment ineffective?
pathways.nice.org.uk/pathways/hyper…
5️⃣ Race is not important in use other guidance with the use of ACE inhibitors in other guidance, e.g. heart failure
nice.org.uk/guidance/ng106
nice.org.uk/guidance/qs99
6️⃣ Some say ACE inhibitor associated angioedema is much higher in Afro-Caribbeans. Is it? A 2006 meta-analysis with mostly US data found the rate was 0.43% compared to 0.18% for White people. Is it relevant esp later in the guidance?
bmj.com/content/332/75…
7️⃣ Some say that ACE inhibitor/ARB are associated with an increased stroke risk from a 2018 meta-analysis with mostly US data, without including trials that measured relevant confounders such as discrimination or poverty.
onlinelibrary.wiley.com/doi/epdf/10.11…
It's not about moral or some anti-racist virtue signal.
It's about questioning the science behind race and whether it serves our patients well.
@NICEComms - does it?
\\ ENDS //
@NICEComms @threadreaderapp unroll please, thank you 🙏🏽
Share this Scrolly Tale with your friends.
A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.