Personalised medicine for hypertensionBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4697 (Published 28 July 2011) Cite this as: BMJ 2011;343:d4697
- Morris J Brown, professor of clinical pharmacology, University of Cambridge
- 1Clinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK
The two broad reasons for tailoring antihypertensive treatment are that susceptibility to complications from treatment varies between people and hypertension has a variety of causes. It is well known that people with asthma should avoid β blockers and that men should avoid higher doses of spironolactone (because of gynaecomastia); the National Institute for Health and Clinical Excellence (NICE) will soon be recommending diuretics over calcium blockade in the very elderly (>80 years) because of superior efficacy in preventing heart failure.1
More interesting but more challenging is whether treatment can be tailored to the pathogenesis of hypertension in individual patients. Hypertension has multiple causes, so treating all patients the same way is as illogical as it would be to treat all cases of anaemia with vitamin B12 or all cases of pneumonia with penicillin. Recent prospective randomised trials and post-hoc analyses of earlier trials and accompanying editorials provide the evidence and impetus needed to implement plasma renin measurement as the “bacteriology” of hypertension.2 3 4 5
Although the early promise of genetic studies in hypertension and the availability of multiple distinct classes of effective drugs first prompted the exploration of individual variation in response, practical pharmacogenetics in hypertension now seems far off. Of 29 common variants so far associated with blood pressure, only one explains even 1 mm Hg of variance in blood pressure.6 The inference is that many hundreds, maybe thousands, of variants are needed to explain the inherited component of hypertension.
In contrast, the …