Has pharmacogenetics brought us closer to 'personalized medicine' for initial drug treatment of hypertension?

Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA.
Current opinion in cardiology (Impact Factor: 2.7). 08/2009; 24(4):333-9. DOI: 10.1097/HCO.0b013e32832c58ba
Source: PubMed


To describe recent advances in antihypertensive pharmacogenetics and discuss challenges related to translating this knowledge into 'personalized medicine' for the initial drug treatment of hypertension.
Recent studies included both prospective and retrospective analyses ranging from small clinical investigations of 42 participants to large, multicenter, randomized, outcome-based clinical trials of nearly 40 000 individuals. Treatment with drugs from five classes of antihypertensives was evaluated in these studies. The duration of treatment ranged from week-long follow up for blood pressure response to a decade-long follow up for clinical outcomes. In total, associations with 12 different candidate genes were assessed. These studies present the now familiar mixture of significant and nonsignificant pharmacogenetic findings that are sometimes consistent with, sometimes inconsistent with, previous findings in antihypertensive pharmacogenetics.
Recent research in antihypertensive pharmacogenetics has added to the existing evidence base, and novel genes and variants as well as new methodologies are cause for continued optimism. However, translation of genomic science to clinical settings has not kept pace with growing interest in personalized medicine for hypertension. New research paradigms may be needed to translate pharmacogenetics into clinical tools. Clinical application will also require a trained clinical workforce, validated genetic tests, and payers willing to fund pretreatment testing.

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    • "The association between BP lowering with beta-blockers and genetic polymorphisms in the beta1-adrenergic receptor gene (ADRB1)- Ser49Gly and Arg389Gly, suggest greater BP lowering in the Arg389Arg individuals. The commonly studied is the Arg389Gly polymorphism, for which many, but not all, studies show a significant association with antihypertensive response to beta-blockers and two independent studies have suggested an association between treatment related hypertensive outcomes and ADRB1 SNPs [38,39,40]. There is some evidence that the Ser49Gly polymorphism alone does not importantly influence BP response, but when considered in combination with the Arg389Gly polymorphism, it may be more informative than Arg389Gly alone [41,42]. "
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