Thread by @DipeshGopal

@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?

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@NICEComms @threadreaderapp unroll please, thank you 🙏🏽