Doctors from the University of Wisconsin (Milwaukee, WI) suggest that precision medicine and epigenetics are two emerging fields that could alter the way in which hypertension is treated.
Recent US studies of hypertension have found that almost half of all patients being treated for the condition are taking more than one drug and that high blood pressure remains uncontrolled in 40% of patients despite treatment.
In a viewpoint published in the Journal of the American Medical Association, Theodore A Kotchen, MD, Medical College of Wisconsin (Milwaukee, WI), and coauthors proposed that developing better, more personalized therapies could aid the prevention and management of hypertension. Precision medicine was introduced to better account for the unique ways in which patients with the same condition respond to treatment. Efforts in precision medicine focus mostly on genomic sequencing, which can be vital for identifying genetic subtypes of diseases such as cancer that may be more or less likely to respond to particular treatments.
Yet, understanding the genome alone does not account for the environmental and lifestyle factors that contribute to conditions such as hypertension. The influence of these factors can only be understood by analyzing epigenetics. Epigenetics has been shown to be a major factor in the development of hypertension.
Applying these two strategies together to hypertension, authors argued, could help physicians better understand which subgroups of patients are most at risk of developing the condition and which treatments are best for those patients. For example, a 1970s study of standard measurements of plasma renin activity helped propel a new approach for identifying and treating different types of patients with hypertension. Future research could build on this example to find new indicators for how different patients should be managed.
Dr Kotchen and his coauthors wrote, “Precision medicine that incorporates epigenetic analysis is a potentially powerful approach for evaluating the influence of environmental and lifestyle modifications on the heritability of hypertension and for personalizing patient care.”
The authors also noted, however, that these areas of study are still in their infancy, and clinical translation could require a long process of convergence, coordination, and integration among health care professionals across multiple disciplines.
