Personalized Antihypertensive Therapy Taking into Account Pharmacogenetics: Current Data and Implementation in Clinical Practice

Abstract

Personalized medicine based on pharmacogenetic data is considered one of the most promising areas for optimizing antihypertensive therapy. Genetic polymorphism of drug-metabolizing enzymes and antihypertensive drug targets significantly contributes to interindividual variability in treatment response, the incidence of adverse reactions, and the achievement of target blood pressure levels.   Based on the study results, pharmacogenetic profiles were created, identifying groups with favorable, intermediate, and unfavorable prognoses for response to specific drug classes. Patients were divided into a standard therapy group, where drug selection was based on traditional clinical and demographic criteria, and a personalized therapy group, where antihypertensive agents and their doses were selected based on the pharmacogenetic profile. The primary endpoints were the reduction in office systolic and diastolic blood pressure after 12 months and the proportion of patients who achieved target blood pressure values according to Russian clinical guidelines. The simulated results showed that in the personalized therapy group, the average reduction in systolic pressure was 5–7 mmHg, more pronounced, and the proportion of patients with controlled blood pressure reached 78% versus 55% in the standard treatment group. The incidence of adverse drug reactions was lower in the subgroup of patients in whom genetically determined slow or accelerated metabolism of individual drugs was taken into account.  The obtained simulated data are consistent with modern international studies in the field of pharmacogenomics of antihypertensive therapy and highlight the potential for the phased implementation of pharmacogenetic approaches in clinical practice at Russian medical institutions.