Patients with hypertension and certain gene variations experienced varying results with some blood pressure medications, suggesting matching a patient's genotype with certain hypertension medications could result in more favorable outcomes, according to a study in the January 23 issue of JAMA: The Journal of the American Medical Association.
Approximately 71 million individuals in the United States have one or more types of cardiovascular disease (CVD), of whom at least 65 million have hypertension. Although control of hypertension has been improving in recent years, among those treated, only about two-thirds have their hypertension controlled, according to background information in the article. Seeking ways to reduce CVD illness and death by tailoring treatment to a patient's particular genotype has been an area of research, but results have yet to yield therapeutic choices for the clinical setting.
Amy I. Lynch, Ph.D., of the University of Minnesota, Minneapolis, and colleagues conducted a study to examine whether patients with hypertension with minor NPPA (atrial natriuretic precursor A) genotypes (NPPA G664A and NPPA T2238C) randomized to the diuretic chlorthalidone had different outcomes for CVD measures than patients who were randomized to other classes of antihypertensive medication. Previous research has suggested that the NPPA gene may influence the effectiveness of some antihypertensive drugs.
The study included 38,462 participants with hypertension from ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial), a multicenter randomized clinical trial conducted in the United States and Canada. Genotyping was performed from February 2004 to January 2005. Participants were randomly assigned to receive a diuretic (chlorthalidone; n = 13,860), a calcium channel blocker (amlodipine; n = 8,174), an angiotensin-converting enzyme (ACE) inhibitor (lisinopril; n = 8,233), or an alpha-blocker (doxazosin; n = 8,195). Follow-up averaged 4.9 years.