Uppsala, Sweden—How beneficial is personalizing medication in hypertension therapy?

That is the question addressed in a new study from Swedish and Australian researchers, who also looked at the magnitude of the benefit of personalization.

A report in Journal of the American Medical Association on the randomized, double-blind, repeated crossover trial found that blood pressure (BP) response to treatments varied significantly among patients but estimated that personalized treatment choice would on average lead to 4.4 mmHg–lower systolic blood pressure than a fixed choice.

The authors suggested that heterogeneity exists in BP response to drug therapy for hypertension and that personalization of treatment warrants further research.

“Hypertension is the leading risk factor for premature death worldwide,” they noted. “Multiple blood pressure–lowering therapies are available but the potential for maximizing benefit by personalized targeting of drug classes is unknown.”

The study team sought to investigate and quantify the potential for targeting specific drugs to patients. Included as participants were men and women with grade 1 hypertension at low risk for cardiovascular events at an outpatient research clinic in Sweden. Participants were scheduled for treatment in random order with four different classes of blood pressure–lowering drugs:

• Lisinopril (angiotensin-converting enzyme inhibitor)
• Candesartan (angiotensin-receptor blocker)
• Hydrochlorothiazide (thiazide)
• Amlodipine (calcium channel blocker), with repeated treatments for two classes.

The researchers focused on ambulatory daytime systolic BP, measured at the end of each treatment period. In 270 of the 280 randomized participants (54% men; mean age, 64 years), 1,468 completed treatment periods (median length, 56 days) were recorded.

The results indicated that the BP response to different treatments varied considerably among patients, especially for lisinopril versus hydrochlorothiazide, lisinopril versus amlodipine, candesartan versus hydrochlorothiazide, and candesartan versus amlodipine. The researchers excluded large differences for the choices of lisinopril versus candesartan and hydrochlorothiazide versus amlodipine.

“These data reveal substantial heterogeneity in blood pressure response to drug therapy for hypertension, findings that may have implications for personalized therapy,” the authors concluded.

Background information in the article pointed out that the global number of hypertension patients has doubled in the last 30 years. The authors advised that only one in four women and one in five men with hypertension reach treatment targets, adding, “While most hypertension guidelines advocate combination pharmacotherapy, many patients in routine care continue to be treated with monotherapy, with adverse effects and nonadherence being important clinical problems.”

The researchers noted that in clinical practice, variations in serial clinic and home measures of BP often are misinterpreted as indicating treatment effects. “In fact, differences due to normal within-person variation in BP are generally much larger than the differences achieved by titrating a BP-lowering drug,” they wrote.

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