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Clinicians' perspectives on race-specific guidelines for hypertensive treatment
Chantal J Rabay1, Carolina Lopez1, Samantha Streuli2
1Department of Anthropology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
Social Science & Medicine (1982)
|May 12, 2024
Summary
Racial guidelines in hypertension treatment are inconsistently applied by clinicians when patient data conflicts. Evidence suggests removing race from guidelines may reduce health disparities.
Area of Science:
- Medical Ethics and Health Disparities
- Clinical Practice Guidelines
- Pharmacogenomics and Race
Background:
- Race is often used in medicine as a proxy for unmeasured factors, despite lacking a biological basis.
- Hypertension treatment guidelines, such as the JNC 8, include race-specific medication recommendations.
- There is limited evidence supporting physiological differences in drug response based on race.
Purpose of the Study:
- To examine how clinicians prioritize racial cues (ancestry, phenotype, self-identification) in hypertension treatment decisions.
- To investigate clinician decision-making when patient racial data conflicts with race-specific guidelines.
- To assess the impact of race-specific guidelines on clinical practice and potential health disparities.
Main Methods:
- In-depth interviews with 21 family or geriatric medicine clinicians.
- Clinicians viewed mock patient videos with discordant genetic ancestry, phenotype, and self-identified race.
- Analysis of how clinicians valued and prioritized different racial cues and factors in treatment decisions.
Main Results:
- Clinicians inconsistently applied race-specific hypertension guidelines when patient racial data was discordant.
- Clinicians' definitions of race, categorization, and prioritization of racial cues varied significantly.
- Clinical experience and other factors influenced decisions, alongside uncertainty regarding genetic ancestry integration.
Conclusions:
- Race-specific hypertension guidelines influence treatment decisions, but their clinical justification warrants re-evaluation.
- The inconsistent application highlights challenges in using race in clinical decision-making.
- Removing race from guidelines may mitigate the risk of perpetuating health disparities in hypertension management.
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