Hypertension pharmacogenomics: in search of personalized treatment approaches

• Published in: Nature reviews. Nephrology Vol. 12; no. 2; pp. 110 - 122
• Main Authors: Cooper-DeHoff, Rhonda M., Johnson, Julie A.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-02-2016; Nature Publishing Group
• Subjects: 631/208/212/1728; 631/61/212/2166; 692/4019/592/75/243; 692/4022/1585/104; Antihypertensive Agents - therapeutic use; Antihypertensive drugs; Antihypertensives; Biomarkers; Blood pressure; Cardiovascular disease; Collaboration; Drug metabolism; Drug therapy; Genetic aspects; Genetic research; Humans; Hypertension; Hypertension - drug therapy; Hypertension - genetics; Medicine & Public Health; Mortality; Nephrology; Patient outcomes; Pharmacists; Pharmacogenetics; Plasma; Precision Medicine; review-article; United States > US
• ISSN: 1759-5061; 1759-507X
• DOI: 10.1038/nrneph.2015.176

Key Points
Hypertension is an important, modifiable risk factor for cardiovascular and kidney disease
Rates of blood pressure control are substantially below the desired levels globally, with many factors contributing to poor blood pressure control
Pharmacogenomics and other 'omics' approaches could help to identify useful biomarkers for a more personalized or precision approach to antihypertensive treatment strategies
Validating and replicating antihypertensive pharmacogenomics signals will require large sample sizes and will probably not yield a single signal with a large effect size, but rather multiple signals with small effect sizes
As technology continues to evolve and genetic and other 'omics' data become available from collaborative studies, identification of biomarkers of blood pressure response might be possible
Hypertension is an important risk factor for cardiovascular and renal disease; however, despite the availability of several antihypertensive drug classes only about half of patients with treated hypertension achieve appropriate blood pressure control. This Review describes the potential of pharmacogenomics and other 'omics' approaches to identify genetic signals to predict an individual's response to a particular drug and enable a more personalized, or precision approach to antihypertensive treatment strategies.
Cardiovascular and renal diseases are associated with many risk factors, of which hypertension is one of the most prevalent. Worldwide, blood pressure control is only achieved in ∼50% of those treated for hypertension, despite the availability of a considerable number of antihypertensive drugs from different pharmacological classes. Although many reasons exist for poor blood pressure control, a likely contributor is the inability to predict to which antihypertensive drug an individual is most likely to respond. Hypertension pharmacogenomics and other 'omics' technologies have the potential to identify genetic signals that are predictive of response or adverse outcome to particular drugs, and guide selection of hypertension treatment for a given individual. Continued research in this field will enhance our understanding of how to maximally deploy the various antihypertensive drug classes to optimize blood pressure response at the individual level. This Review summarizes the available literature on the most convincing genetic signals associated with antihypertensive drug responses and adverse cardiovascular outcomes. Future research in this area will be facilitated by enhancing collaboration between research groups through consortia such as the International Consortium for Antihypertensives Pharmacogenomics Studies, with the goal of translating replicated findings into clinical implementation.