Investigating the Use of Genetics to Guide Pharmacologic Therapy for Hypertension

Hypertension is one of the most important preventable contributors to disease and death in
the United States and represents the most common condition seen in the primary care setting.
Approximately 78 million adults living in the U.S. have hypertension with more than 5 million
new diagnoses made each year. Unfortunately, despite a significant impulse in the medical
community to move towards an "individualized medicine" approach to patient centered
treatment, the current clinical treatment strategy is based on a set algorithm which does not
take into account individual patient differences. As a result hypertension is often
sub-optimally treated based on "population averages", rather than a person's genetic make-up,
with significant burden on our health care system. In fact, 40% of patients who are adherent
to their blood pressure therapy (taking their medicines as prescribed by their clinician) do
not have their blood pressure under control. Previous work has demonstrated significant
functional polymorphisms within the kidney, vessels, and heart that will likely predict a
patient's response to blood pressure pharmacotherapy. Previous work by our group, utilizing a
retrospective design, has determined that the addition of genetic knowledge to prescribing
can improve therapeutic guidance and decrease the time to blood pressure control
significantly. Despite this, to date, there are no prospective trials to guide blood pressure
therapy using multiple organ systems that are important in the three most common classes of
drugs: diuretics, vasodilators, and beta-blockers. The objective of this clinical trial is to
determine the efficacy of genetically guided therapeutic options for pharmacologic treatment
of essential hypertension in newly diagnosed patients.