Treating black hypertensive patients: limited applicability of the guideline recommendations

• Published in: Nederlands tijdschrift voor geneeskunde Vol. 165
• Main Authors: Bakkum, M J, Muntinga, M E, Verdonk, P, Tichelaar, J
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 15.04.2021
• Subjects: Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - therapeutic use; Black or African American; Black People - statistics & numerical data; Blood Pressure - drug effects; Diuretics - therapeutic use; Ethnicity - statistics & numerical data; Health Status; Humans; Hypertension - drug therapy; Hypertension - ethnology; Netherlands; Professional-Patient Relations; Netherlands
• ISSN: 0028-2162; 1876-8784

Self-identified black patients respond better to calcium channel blockers and diuretics, than to renin-angiotensin-system inhibiting agents. This has been translated into sensitive guideline recommendations to treat black patients differently than others. We argue that such recommendations have limited applicability. Studies that shaped these recommendations selected patients on the basis that they self-identify as Black. This self-identification is often considered synonymous to having an African ancestry, but ancestry is but one of the many factors that constitutes one's self-identification. Moreover, if any, the African roots of these patients are often many generations old. Patients that self-identify as Black are likely to have ancestors from other races that co-determine their response to antihypertensive medications. The ancestry of black Dutch patients is diverse, and incomparable to black American or African patients. Therefore it is ill-advised to treat Dutch patients based on associations found in these populations. Studies in more comparable populations are scarce and contradictory.