Daily Pharmacy News

Get your free subscription started now. Just enter your email address below.

Heterogeneity in Antihypertensive Drug Response & the Need for Personalized Therapy

Wide variations in responses to antihypertensive agents in a randomized controlled trial suggest the possibility of personalized therapy for patients with hypertension. “Given the size of the likely benefits, additional studies to confirm these findings, to test for the potential of personalization of combination antihypertensive therapy, and to identify mechanisms to enable the personalization of antihypertensive therapy in routine clinical practice should be a priority,” the Precision Hypertension Care (PHYSIC) Trial investigators conclude.

Men and women with grade 1 hypertension at low risk for cardiovascular events participated in the randomized, double-blind, repeated crossover trial at an outpatient research clinic in Sweden. Participants were scheduled for treatment with 4 different classes of blood pressure–lowering drugs (lisinopril, candesartan, hydrochlorothiazide, and amlodipine), with repeated treatments for 2 classes.

Based on a main outcome of ambulatory daytime systolic blood pressure at the end of each treatment period, the study found: “There were 1,468 completed treatment periods (median length, 56 days) recorded in 270 of the 280 randomized participants (54% men; mean age, 64 years). The blood pressure response to different treatments varied considerably between individuals (P < .001), specifically for the choices of lisinopril vs hydrochlorothiazide, lisinopril vs amlodipine, candesartan vs hydrochlorothiazide, and candesartan vs amlodipine. Large differences were excluded for the choices of lisinopril vs candesartan and hydrochlorothiazide vs amlodipine. On average, personalized treatment had the potential to provide an additional 4.4 mm Hg–lower systolic blood pressure.”

Editorial: “The PHYSIC trial demonstrates the feasibility of a personalized approach to the treatment of hypertension by bringing to light the heterogeneity of BP responses to single antihypertensive agents of different pharmacological classes,” writes an editorialist. “The results of this study encourage the further pursuit of larger randomized trials using similar repeated crossover designs to validate this concept and eventually in trials with longer follow-up data to determine whether there is improvement in long-term clinical outcomes compared with current strategies. In the meantime, the results of this study support the possibility that personalized medical treatment of hypertension may ultimately supplement or even supplant the current method of antihypertensive drug decision-making in the future.”

Source: JAMA