PERSONALIZED THERAPY IN CARDIOLOGY: THE ROLE OF PHARMACOGENETICS AND BIOMARKERS IN THE SELECTION OF ANTIHYPERTENSIVE AND ANTIPLATELET AGENTS - POTENTIAL AND LIMITATIONS OF IMPLEMENTATION

Abstract

The introduction of pharmacogenetic testing in the selection of pharmacotherapy can help optimize the choice of drugs to achieve better treatment results in patients by increasing the effectiveness of therapy and preventing undesirable side effects.

The aim of the work is to determine which pharmacogenetic tests and clinical biomarkers are already changing

The study provides an analytical review with elements of secondary quantitative synthesis. For sources with available outcome frequencies, absolute risk differences and approximate NNT values are additionally calculated. The most mature implantation zone was identified for CYP2C19 when choosing P2Y12 inhibitors after acute coronary syndrome and PCI. In carriers of alleles with reduced function, clopidogrel works less effectively, whereas switching to ticagrelor or prasugrel can reduce the ischemic residual risk.

Rather than broad genetic panels, biomarkers of phenotype and safety, such as plasma renin activity, aldosterone/renin ratio, albuminuria, eGFR, and potassium, are more useful in antihypertensive therapy. Personalization already provides the greatest impact where the marker is integrated into a short prescribing algorithm and is available on time, coinciding with the speed of the clinical solution.

The limiting factors remain the ethnic heterogeneity of the results, the organizational cost of testing, and the lack of uniform algorithms for most antihypertensive pharmacogenetic signals.