Pharmacogenomics-guided therapy for essential hypertension: a multi-center randomized controlled open-label trial.

Variants at seven loci (ADRB1, CYP2D6, CYP3A5, CACNA1C, CYP2C9, ACE, ADD1), linked to five major antihypertensive drug classes, guide drug selection.

This multicentre open-label randomised trial enrolled 2,702 patients with essential hypertension across 14 hospitals in Hunan Province (China), allocated to standard care or pharmacogenomics-tailored treatment. Seven loci (ADRB1, CYP2D6, CYP3A5, CACNA1C, CYP2C9, ACE, ADD1) were analysed, with risk allele frequencies ranging from 4.8% (CYP2C9) to 74.8% (ADRB1). At 4 weeks, blood pressure fell in both groups (all P < 0.001), more markedly in the genotype-guided group (from 155.45/92.12 to 129.03/76.96 mmHg) than in controls (from 156.52/91.75 to 143.74/82.73 mmHg). The blood pressure control rate was also significantly higher in the guided group.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

A randomised trial of this size in cardiovascular pharmacogenetics is rare, and the blood pressure gap looks substantial. It should nonetheless be read cautiously: follow-up is 4 weeks, the design is open-label, and the abstract specifies neither the control-arm treatments nor the weight of each locus; transfer beyond this Chinese population remains to be shown.

Analysis by Dr Thibaut Benquey