Abstract
Hypertension (HTN) is a complex disease with interactions among multiple organ systems, including the heart, vasculature, and kidney with a strong heritable component. Despite the multifactorial nature of HTN, no clinical guidelines utilize a multi-gene approach to guide blood pressure (BP) therapy. Non-smokers with a family history of HTN were included in the analysis (n = 384; age = 61.0 ± 0.9, 11% non-white). A total of 17 functional genotypes were weighted according to the previous effect size in the literature and entered into an algorithm. Pharmacotherapy was ranked from 1–4 as most to least likely to respond based on the algorithmic assessment of individual patient’s genotypes. Three-years of data were assessed at six-month intervals for BP and medication history. There was no difference in BP at diagnosis between groups matching the top drug recommendation using the multi-gene weighted algorithm (n = 92) vs. those who did not match (n = 292). However, from diagnosis to nadir, patients who matched the primary recommendation had a significantly greater drop in BP when compared to patients who did not. Further, the difference between diagnosis to current 1-year average BP was lower in the group that matched the top recommendation. These data suggest an association between a weighted multi-gene algorithm on the BP response to pharmacotherapy.
Highlights
Hypertension (HTN) is a major preventable contributor to cardiovascular disease (CVD) and accounts for approximately 360,000 of the 2.4 million (14%) annual deaths in the United States [1,2,3]
Patients were grouped into those who were on the current prescription for drug therapy which matched to the top recommendation provided from the algorithm vs. those who did not match (Table 3)
We found that there was no significant difference in the drop in blood pressure between patients matching recommendation one or recommendation two, but that patients who did match were slightly more likely to have their BP under control with the newer Systolic Blood Pressure Intervention Trial (SPRINT) guidelines (27% vs. 22% for those matching recommendation one or two vs. those who did not match, respectively) (Table 7)
Summary
Hypertension (HTN) is a major preventable contributor to cardiovascular disease (CVD) and accounts for approximately 360,000 of the 2.4 million (14%) annual deaths in the United States [1,2,3]. High blood pressure represents an estimated $51 billion in direct costs to the United States health care system [4]. While 70% of HTN patients are treated, only half of those achieve blood pressure (BP) control (BP < 140/90 mmHg) [9]. These poor control rates, despite high treatment rates, suggest that the efficacy of BP therapy goes beyond adherence. This is further supported by detailed studies that have demonstrated an average effective rate of 50% for each common class of BP medication (diuretic, ACE-inhibitors, angiotensin-II receptor blockers, beta-blockers) [10], even when adherence is confirmed. Most HTN pharmacotherapies demonstrate a bell-curve response, such that a majority of patients have a reduction or no change in BP, but 10–20% of patients demonstrate an increase in BP [11,12]
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