Personalized Pharmacotherapy for Hypertension: Examining Intra-patient Variability

Authors:
Anthony Ishak, PharmD, BCPS

Reviewers:
Augustus (Rob) Hough, PharmD, BCPS, BCCP
Megan Supple, PharmD, BCACP

Citation:
Sundstrom J, Lind L, Nowrouzi S, et. al. Heterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs: A Randomized Clinical Trial. JAMA 2023; 329(14):1160-9.

The Problem

Less than 1 in 4 patients with hypertension in the United States have achieved their blood pressure (BP) goal, according to the CDC. The global control rate is even lower, less than 15%.  Perhaps a different treatment approach is needed.¹ The 2017 ACC/AHA and JNC 8 Hypertension guidelines recommend initiating treatment of uncomplicated hypertension with one of four pharmacological classes: thiazide diuretics, angiotensin-receptor blockers (ARBs), dihydropyridine calcium channel blockers, or angiotensin-converting enzyme inhibitors (ACEIs).^2-3 Those with more significantly elevated blood pressure or co-morbidities may require initiation of combination therapy thus increasing regimen complexity, drug interactions, and the risk for non-adherence.^4-6 Many clinicians only think of changing medications if a patient is having an intolerance to the current regimen. However, individual patients might respond differently to each of the four major anti-hypertensive medication classes and, if we could determine in advance which class(es) would lower the blood pressure the most, we could minimize the number of medications eventually needed to attain control.⁷