Inherent inaccuracies and potential utility of race/ethnicity labeling in the treatment of hypertension

The use of racial/ethnic labeling for any purpose is fraught with substantial emotional, social and political consequences even when used for demographic studies or census. In addition to the very real historical conflicts associated with slavery in the Americas and various social classification systems elsewhere, such labeling has been shown by the use of ancestral identification markers to be inaccurate in many cases. Even geographic labeling, such as East Asians, ignores the marked heterogeneity of East Asians. The use of race alone to determine selection of initial antihypertensive therapy is a very limited approach. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents has demonstrated, however, that the use of age and race together may be a useful paradigm for predicting response to a single antihypertensive drug. Furthermore, individuals from populations who consume high levels of sodium and lower levels of potassium may respond better to diuretics and calcium antagonists. Other populations may be more susceptible to angioedema or cough related to the use of angiotensin-converting enzyme inhibitors. Such information may be useful for the selection or avoidance of certain medications. No patient should ever be denied indicated treatment with a drug or drug class because of race or ethnicity.