[Treating black hypertensive patients: limited applicability of the guideline recommendations]

Area of Science:

• Pharmacogenomics
• Cardiovascular Medicine
• Medical Ethics

Background:

• Current hypertension guidelines recommend race-based treatment strategies, particularly for self-identified Black patients.
• These recommendations are often based on studies where self-identification as Black is equated with African ancestry.
• However, self-identification is complex and influenced by multiple factors beyond ancestry, which may be many generations removed.

Purpose of the Study:

• To critically evaluate the applicability of race-based treatment recommendations for hypertension in self-identified Black patients.
• To highlight the limitations of equating self-identified race with specific ancestral origins in pharmacotherapy.
• To examine the diversity of ancestry in specific populations, such as Black Dutch patients, and its implications for treatment.

Main Methods:

• Review of existing clinical guidelines and landmark studies informing race-based hypertension treatment.
• Analysis of the concept of self-identification versus genetic ancestry in clinical research.
• Examination of population-specific data on ancestry and drug response, with a focus on diverse populations.

Main Results:

• Studies supporting race-based treatment often rely on self-identified race, which may not accurately reflect ancestry.
• Self-identification as Black can encompass diverse ancestral backgrounds, including non-African origins, influencing medication response.
• The ancestry of Black Dutch patients is notably diverse and dissimilar to Black American or African cohorts, questioning the direct applicability of existing findings.

Conclusions:

• Race-based treatment guidelines for hypertension may have limited clinical utility due to the heterogeneity of ancestry within self-identified racial groups.
• Treating patients based on broad racial categories without considering specific ancestral admixture can lead to suboptimal therapeutic outcomes.
• Further research is needed in more genetically comparable populations to refine personalized antihypertensive treatment strategies.