UC San Diego

Despite the general consensus that there is no biological basis to race, racial categorization is still used by clinicians to guide diagnosis and treatment plans for certain diseases. In medicine, race is commonly used as a rough proxy for unmeasured social, environmental, and genetic factors. The American College of Cardiology’s Eighth Joint National Committee’s (JNC 8) guidelines for the treatment of hypertension provide race-specific medication recommendations for Black versus non-Black patients, without strong genetic evidence for racial differences in drug response. Clinicians practicing family or geriatric medicine (n=21) were shown a video of a mock hypertensive patient with genetic ancestry results that were discordant with their phenotype and self-identified race. After viewing the videos, we conducted in-depth interviews to examine how clinicians value and prioritize different cues about race -- namely genetic ancestry data, phenotypic appearance, and self-identified racial classifications – when making treatment decisions in the context of race-specific guidelines, particularly in situations with patients of mixed-race. Results indicate that clinicians inconsistently follow the race-specific guidelines for patients with unexpected genetic ancestry relative to their skin color and facial features, and many emphasized clinical experience, side effects, and other factors in their decision-making. Clinicians’ definitions of race, categorization of the patient’s race, and prioritization of racial cues greatly varied. The existence of the guidelines clearly influences treatment decisions even if clinicians were unsure of how to incorporate consideration of the patients’ genetic ancestry. More research is needed to determine if there is a true racial difference in medication response and if guidelines exacerbate racial disparities in hypertension, and researchers should revisit the clinical justification for maintaining these race-specific guidelines.