African Ancestry vs. Creatine Kinase to Predict Hypertension Control: Time for a Change?

Area of Science:

• Cardiovascular Medicine
• Biochemistry
• Genetics

Background:

• Hypertension guidelines consider African ancestry separately due to perceived harder-to-control hypertension.
• Racial profiling in medicine faces criticism for potential bias and stereotyping.
• Investigated creatine kinase (CK) as a potential predictor of hypertension therapy failure.

Purpose of the Study:

• To compare the predictive performance of African ancestry versus resting plasma CK for uncontrolled hypertension.
• To determine if CK is a more proximate causal parameter of therapy failure than race/ancestry.

Main Methods:

• Analysis of a random multiethnic population sample (1,405 individuals).
• Comparison of African ancestry and resting plasma CK levels as predictors of treated uncontrolled hypertension.
• Primary outcome measure: difference in area under the receiver operating curve (AUC).

Main Results:

• Hypertension prevalence was higher in African ancestry participants (39%) vs. non-African (29%).
• Hypertension control rates were similar by ancestry (40% vs. 41%) but differed significantly by CK levels (27% high CK vs. 53% low CK).
• Area under the curve (AUC) was 0.51 for African ancestry vs. 0.64 for log CK, indicating CK was a better predictor (P=0.02).

Conclusions:

• Resting plasma CK may identify hypertensive patients at risk for therapy failure across diverse ancestry groups.
• CK could serve as an impartial predictor of antihypertensive therapy failure.
• Further prospective studies are needed to confirm the clinical utility of CK testing.