The Construction and Meaning of Race within Hypertension Guidelines: A Scoping Review

Context: Professional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. In the context of increased recognition of the role racism has played in shaping medical practices, many healthcare researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. These critiques question how implicit—and sometimes explicit—racism has influenced both the evidence that guidelines are based on and the interpretation of that evidence.

Objective and study design: In this study, we conducted a scoping review of all professional guidelines focused on the treatment and management of essential hypertension published between 1977 and 2020 and examined how race and ethnicity influenced guideline recommendations.

Results: We found that authors largely focused on Black and White categories, with few references to other groups. Guideline authors described race as a distinct, preestablished category with biological underpinnings (for example, recommended specific medication classes to a predefined racial group). No guideline discussed the history of racism and the role it has played in perpetuating hypertension (or other health) disparities or inequities. The characterizations of race in essential hypertension guidelines normalize race as a biological rather than social construct.

Conclusion: As the health system grapples with how to address racism in medicine, exploring how professional care guidelines reflect an outdated understanding of race can help us understand both the social origins of and treatments for hypertension inequities.