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Medical Response Not All Black and White

WebMD Health News
Reviewed by Gary D. Vogin, MD

May 2, 2001 -- The problem of race has insinuated itself into virtually every aspect of American life, and medicine is no exception. Recently, researchers have become intrigued by what appear to be racial differences in reaction to specific treatments -- especially differences in how black and white patients respond to common drugs used for heart disease and high blood pressure.

Two separate reports, and accompanying editorials, appearing in this week's The New England Journal of Medicine, examine the complex question that surround these apparently racial differences. And although the reports come to different conclusions about different drugs, the authors and other experts agree: The reasons for those differences are liable to lie somewhere deeper than skin.

In one of the studies, researchers found that blacks and whites respond in significantly different ways to a drug called Vasotec, commonly used for chronic heart failure.

Author Jay Cohn, MD, professor of medicine at the University of Minnesota School of Medicine, in Minneapolis, explains that the study was a retrospective one, looking at long-term outcome of patients who had been treated with the drug previously. What they found was disturbing: After one year of treatment, white patients had a significant drop in blood pressure that was not experienced by black patients.

Furthermore, white people experienced a 44% reduction in later hospitalization, while black people experienced no significant reduction, according to the report.

A second report showed more equality in treatment results. In that study, researchers found that a drug called Coreg for chronic heart failure was as effective in black patients as in white ones. Specifically, the drug reduced the risk of death by 48% in black patients, and by 30% in nonblack patients.

Author Clyde W. Yancy, MD, explains that Coreg is a new type of "beta-blocker," a class of drugs which work by affecting nerve impulses that control the heartbeat, helping the heart to beat more regularly. The beneficial effects of Coreg in black Americans, not seen in other beta-blockers, may be due to the fact that it is more sensitive to how those nerve impulses control heartbeat in all people -- but especially sensitive to underlying differences found in black patients, Yancy says.

"This is the first time we have demonstrated that a specific therapy is effective in African-Americans," Yancy tells WebMD. "We know there is a disproportionate incidence of heart failure in African-Americans and a growing concern that traditional therapies may not work as well. We have emphatically demonstrated that in this cohort of patients treated with [Coreg], there was a similar benefit in blacks and whites."

He is associate professor of medicine and cardiology at the University of Texas Southwestern Medical Center, in Dallas.

The observation of racial differences in response to treatment raises uneasy questions: Can the difference in response truly be related to skin color?

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