1/
🧵
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
🧵
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…
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…
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…
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.
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.
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.
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…
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…
7/
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/…
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…
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?
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.
@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. 🙏🏽
<< 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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