Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Management of hypertension: summary of NICE guidance

BMJ 2011; 343 doi: (Published 25 August 2011) Cite this as: BMJ 2011;343:d4891

Rapid Response:

Recognising 'ethnic' effects

I am grateful to Anas El Turabi and Payne for their intervention,
highlighting the poor quality of evidence available to make prescribing
decisions for British Black (African-Caribbean origin) people. They are
correct in their assertion that we do not know with certainty if this is
the right baseline data for this group, many of whom (as highlighted in
recent TV and media coverage) may in fact belong to the emergent 'mixed'
origin population of the UK, and be genetically significantly different
from the Black American population referred to. However, as the 'BiDil'
controversy in the USA made it clear, at least for a significant
proportion, renin functions and genetic predispositions may mean that
'generic' advice is not totally appropriate either. In other clinical
areas, we also know that people of South Asian or Mediterranean origin may
have varying sensitivities to certain drugs. At least Krause et al have
highlighted the possibility that Black patients might need specific
consideration. Williams' response on behalf of the team also underlines
the need for us to seek more and better research evidence on the efficacy
of treatments in different ethnic groups - and indeed, age groups. It is
not so long since it had to be argued that we needed to have hard evidence
of gender differences in susceptibility to side effects.

This small controversy at least helps to highlight the case that the
UK Centre for Evidence in Ethnicity Health & Diversity (and until
recently, the NHS Evidence 'specialist collection' on ethnicity and
health') has been making for the past 15 years! Can we please ask all
future therapeutic trials to ensure a satisfactory inclusion of minority
ethnic groups - and where appropriate, age groups, to provide safer and
more effective recommendations on the use of treatments?

Competing interests: Dr Johnson directs a programme of research into the delivery of health care services to ethnically diverse communities, and health inequalities and has an interest in there being more and better research in this area. MSRC is the home of CEEHD / NHS E&H.

14 October 2011
Mark RD Johnson
Professor of Diversity in Health & Care
Mary Seacole Research Centre, De Montfort University