PL 01-3 SHOULD HYPERTENSION TREATMENT TARGETS DIFFER ACCORDING TO REGION AND ETHNICITY?

With the exception of a few isolated populations, elevated blood pressure is a worldwide pandemic with staggering consequences for individuals, care givers, health care delivery systems, and insurers, including governments. It is well-recognized that the burden of hypertension and its adverse consequences is greater in low- and middle-income countries than economically developed countries. BP-related outcomes also differ by region, with a predominance of stroke in southeast Asian countries and a predominance of ischemic heart disease in the US and Western Europe. Importantly, there is also substantial variation within-countries and within-regions. Likewise, within-countries and within-regions, there are differences in the prevalence of hypertension and BP-related cardiovascular-kidney outcomes by race-ethnicity. Often, these differences are associated with social and contextual factors, such as poverty and low education. In a few instance, biological factors, such as ApoL1 genotypes, are implicated. A timeless issue is whether regional and ethnic differences should modify therapy, specifically, BP targets. For several reasons, I recommend avoiding treatment strategies that triage medical care based on these 2 factors. First, both region and ethnicity are suboptimal constructs - an individual's home is a malleable, not fixed exposure, and race-ethnicity is not a robust biological construct. Second, such an approach requires evidence, currently unavailable, that the effects of anti-hypertensive therapy differ by region and ethnicity. Third, for mass exposures like hypertension, there is a need for a simplified, pragmatic approach that can be applied broadly, not a highly individualized approach for which there is limited empiric support. In conclusion, hypertension treatment targets should not differ by region or ethnicity.