Medical student Joel Bervell, known as the “Medical Myth Buster” on Instagram, advocates for a holistic approach in treating conditions like hypertension among Black patients. He wants doctors to steer away from race-based prescribing and treatment, citing its potential ineffectiveness in addressing the root causes of their condition.
Bervell recently shared a video on Instagram July 11, where he discussed the common practice among doctors to prescribe different initial treatments for hypertension based on race. This practice, initially highlighted by maternal health expert and family medicine physician Dr. BCW on TikTok, often involves starting Black patients without hypertension with a lower dosage of medications like calcium channel blockers (CCBs) or thiazides (water pills) as a preventive measure.
What are CCBs and thiazides?
CCB medication and thiazides can help to lower blood pressure by relaxing blood vessels and removing excess water and salt from the body. However, studies show that they are less effective in preventing the condition when compared to other anti-hypertensive drugs like Angiotensin-converting enzyme or ACE inhibitors.
Per Mayo Clinic , like CCBs, ACE inhibitors assist the body to relax the veins and arteries in order to lower blood pressure, however, they demonstrate a notable protective effect beyond their blood pressure-lowering properties, whereas CCBs tend to have a comparatively negative impact on complications that can occur due to hypertension such as congenital heart disease (CHD).
Compared to other primary classes of antihypertensive medications, CCBs show less effectiveness in preventing CHD and are linked to a higher incidence of heart failure. Conversely, CCB treatments show greater efficacy in preventing strokes compared to conventional medications, although they do not match the effectiveness of ACE inhibitors in this regard.
Bevell questioned the efficacy of these race-based guidelines as Black Americans are at a greater risk of developing hypertension compared to other races. High blood pressure rates among Black adults in the United States are among the highest globally, affecting approximately 55% of the population, Heart.org notes.
According to one study, Black patients had higher instances of uncontrolled hypertension under race-based prescription guidelines.
To illustrate his point, Bevell cited a 2022 study conducted with over 10,000 participants, in which researchers found Black patients were more likely to have poorly controlled hypertension following race-based prescription guidelines compared to other races.
Researchers studied 10,875 patients and found that 20.6% were Black African American (BAA). Among these, 46.4% had uncontrolled high blood pressure, which was higher than the 39.0% seen in non-BAA patients.
When it came to treatment, 61.8% of BAA patients were on a single medication for hypertension compared to 68.4% of non-BAA patients. Specifically, among those on a single medication, BAA patients commonly used thiazide (41.3%), calcium channel blockers (CCB) (40.1%), or ACE inhibitors/ARBs (18.6%), while non-BAA patients more frequently used ACE inhibitors/ARBs (42.3%), followed by CCBs (30.1%) and thiazides (27.7%).
The study also found that among patients on one medication, 45.2% of BAA patients had uncontrolled hypertension compared to 38.0% of non-BAA patients. For patients on two medications, 48.2% of BAA patients had uncontrolled hypertension compared to 41.1% of non-BAA patients.
Bervell emphasized that factors such as medication adherence, lifestyle adjustments paired with appropriate medications, and individual health considerations may yield better outcomes than race-based prescriptions. For instance, studies indicate that ACE inhibitors, in conjunction with low-dose diuretics, are typically preferred for treating hypertension, while CCBs are often recommended as supplementary therapy.
The medical student stressed the importance of a nuanced treatment approach that takes into account the specific health needs of each patient, rather than solely relying on racial categories. This approach is crucial because hypertension and its treatment requirements can vary not only across ethnic groups but also among individuals within the African diaspora.
Research published in the Journal of the American College of Cardiology underscores these differences, noting that individuals of African descent, including Afro-Caribbeans and Africans in Europe, tend to develop hypertension earlier and experience more severe forms of the condition compared to white populations. Moreover, people of Black ethnicity face an elevated risk of developing organ damage linked to hypertension at younger ages compared to their white counterparts.
In the comments section, fans of the social media star thanked Bervell for his life-saving video .
“I was taught race based medication guidelines in my nursing and nurse practitioner career. Both times I questioned my professors as to ‘why’ is this so,” wrote one user. “Neither occurrences did they give me an answer nor could they produce a study supporting their claims. It is such a shame that these ‘guidelines’ are still being taught in numerous fields of education all throughout the nation. Thank you for your continuous content to help educate!”
Another netizen commented, “Preach! I’m glad you brought up the genetic diversity within Black peoples. We are not a monolith.”
Let’s get healthy and stay healthy out there folks!
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