title: Has pharmacogenetics brought us closer to 'personalized medicine' for initial drug treatment of hypertension?
abstract: OBJECTIVE
  To describe recent advances in antihypertensive pharmacogenetics and discuss challenges related to translating this knowledge into 'personalized medicine' for the initial drug treatment of hypertension.
  
  
  RESULTS
  Recent studies included both prospective and retrospective analyses ranging from small clinical investigations of 42 participants to large, multicenter, randomized, outcome-based clinical trials of nearly 40 000 individuals. Treatment with drugs from five classes of antihypertensives was evaluated in these studies. The duration of treatment ranged from week-long follow up for blood pressure response to a decade-long follow up for clinical outcomes. In total, associations with 12 different candidate genes were assessed. These studies present the now familiar mixture of significant and nonsignificant pharmacogenetic findings that are sometimes consistent with, sometimes inconsistent with, previous findings in antihypertensive pharmacogenetics.
  
  
  CONCLUSIONS
  Recent research in antihypertensive pharmacogenetics has added to the existing evidence base, and novel genes and variants as well as new methodologies are cause for continued optimism. However, translation of genomic science to clinical settings has not kept pace with growing interest in personalized medicine for hypertension. New research paradigms may be needed to translate pharmacogenetics into clinical tools. Clinical application will also require a trained clinical workforce, validated genetic tests, and payers willing to fund pretreatment testing.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA. arnett@ms.soph.uab.edu
authors.forename: Donna K
authors.initials: DK
authors.lastname: Arnett
authors.forename: Steven A
authors.initials: SA
authors.lastname: Claas
authors.forename: Amy I
authors.initials: AI
authors.lastname: Lynch
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015195:Drug Design; D019317:Evidence-Based Medicine; D005838:Genotype; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000235:genetics; D010597:Pharmacogenetics; D012084:Renin-Angiotensin System / Q000187:drug effects; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents