More African Americans needed in drug studies

House Calls

By Gerald W. Deas, M.D.

Finally, it has been recognized that black folks who have hypertension do not necessarily all respond to the same blood pressure medications. When you consider that the gene pool of African Americans is made up not only from the gene pools of Europeans, but also Native Americans as well as Africans from different parts of Africa, it is obvious that their response to medications might be chemically different. Genes regulate every chemical reaction in the body. Whether one gene is absent or missing will determine the outcome of patient response.

Recently, Dr. Henry Louis Gates, the distinguished African American who chairs African American studies at Harvard, found out that his genetic heritage was 50 percent European. This is not surprising since I myself am genetically connected with Europeans and Native Americans.

When drugs are being tested on a population, the African American is not used in any statistical numbers and, therefore, it is obvious that the outcome of that drug would not represent our gene pool. Often, as a practicing physician, I have observed that many of my patients with hypertension did not respond uniformly to the same drugs. Each patient’s condition had to be tailored.

Recently, a new drug was approved by the U.S. Food and Drug Administration (FDA), namely Bi- Dil which was developed and proven to be more effective in the control of congestive heart failure in African Americans. More of these drug types will have to be developed to cover the large span of African Americans who have hypertension which are not responding to the drugs that are available. When a patient is introduced to a new drug which they do not respond to, they not only experience adverse side effects but also can refuse to take the medication and thus leave hypertension uncontrolled subsequently leading to congestive heart failure and strokes.

There were no drugs for the treatment of hypertension until 1955. African Americans used folk medicine, which consisted of a mixture of Epson Salts and grapefruit juice. The throbbing in the head due to the elevated pressure was relieved. Little did they know that the Epsom Salts was pure magnesium sulfate. It has been subsequently shown that magnesium is an element that relaxes the walls of arteries, thus reducing the pressure. Where this practice developed, no one really knows, but it worked. The first drug that could be taken orally was hydrochlorothiazide (a water pill). Unfortunately, this pill caused a loss of potassium. The mineral magnesium was also lost, causing the patient to experience low magnesium thus, causing cardiac irritability and other symptoms due this loss. It was a long time before this was realized and this mineral, magnesium was given to the patient as a supplement.

It is evident from the above discussion, that the approach in treating African Americans must be reevaluated. This can only be accomplished by using more African Americans in trial studies if we are going to prevent early death from hypertensive heart failure and end stage kidney disease.

What’s Up? Drug companies must engage more African Americans in their studies of new drugs such as hypertension, which is “the silent killer.”

This is part of the August 5, 2009 online edition of Frost Illustrated.

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