Hypertension is a common yet dangerous medical condition. Treatments have long been established; however, the use of race in treatment guidelines is being questioned.
Hypertension is defined as high blood pressure. Blood pressure describes the force blood exerts on vessel walls, measured during systole (when the heart beats) and diastole (when the heart rests between beats). In a blood pressure reading of 120/80, the first number is systolic and the second is diastolic. According to the American Heart Association, blood pressure less than 120/80 is healthy, while 130/80 or greater indicates hypertension. Hypertension can damage blood vessels and organs and increase one’s risk for serious heart conditions.
Checking blood pressure regularly is important to determine if one has hypertension
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Treatments to reduce BP and control hypertension include lifestyle changes (e.g. exercise) and medications. Medications include three classes: angiotensin-converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics. They affect the angiotensin hormone (which narrows blood vessels), calcium levels, and body fluid volume, respectively.
While all of these medications decrease blood pressure, they do so differently. The question arises, which is the most effective medication? Physicians previously believed it depended on the patient’s race.
For years, race has been used in prescription guidelines. Black patients are prescribed CCBs and diuretics, whereas non-Black patients are prescribed any of the three classes. These guidelines are based on the ALLHAT trial that showed diuretics and CCBs to be more effective than ACEs in improving heart health in Black patients. This is supposedly because these medications directly address the causes of hypertension. Research shows that hypertension in Black people is often caused by a reduced ability to excrete sodium and a high calcium concentration in the cells. Therefore, diuretics address the sodium problem by removing sodium-containing fluid, and CCBs address the calcium issue by reducing heart calcium levels.
Although race-based prescription may seem effective, it really isn’t. The lack of clarity on how race is determined forces physicians to use vague, inconsistent criteria to classify race. This is a major flaw in the ALLHAT trial that supposedly justifies race-based guidelines. Another flaw is ALLHAT’s divergence from the initial objective of comparing the efficacies of different medications, to determining the best first-step medication for patients. ALLHAT doesn’t account for the fact that most subjects were already on hypertension medications, so drugs used during the study weren’t their first treatment. Further, as race is widely regarded as a socio-political construct without biological significance, its general use in healthcare is criticized. Thus, the validity of ALLHAT’s findings and the benefit of race-based guidelines have been questioned.
Thankfully, medicine has begun discarding this practice. Medical organizations have started removing race from treatment guidelines and emphasizing more holistic, individualized care instead. These changes will hopefully provide real, equal benefits to patients of all races.
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