In the not-too-distant future, it may be possible to know if a patient is going to have high blood pressure before the condition ever manifests. Genomic-based diagnosis and treatment of hypertension is still in its infancy, but there are cues physicians can use today to improve outcomes around the disease.
Although the biological pathways that lay the groundwork for blood pressure control are complex and not completely understood, evidence suggests that genetics plays a large roll. Potentially up to 60 percent of hypertension risk can be explained by additive genetic factors, according to a new report by the AMA Council on Science and Public Health. For this reason, family history is a valuable indicator of a patient’s likelihood of developing hypertension.
Soon, genetic testing may help predict hypertension early and assist in determining individual response to anti-hypertensive medications. “Although no clinical practice guidelines recommend genotyping before initiating antihypertensive therapy, an awareness of the pharmacogenomic factors affecting response to antihypertensive agents is important for anticipating various responses to prescribed medications and altering treatment when blood pressure levels are not satisfactorily lowered,” the report said.
But furthering genomic research in hypertension is difficult because of the many factors that can influence blood pressure levels, including where and when a patient’s blood pressure is measured. Because even small changes in blood pressure levels can impact cardiovascular outcomes, heterogeneity in clinical trial populations in genomic studies can lead to results that are difficult to interpret and apply to clinical care.
Physicians passed policy at the 2014 AMA Interim Meeting to support clinical trials that attempt to reduce this heterogeneity. The new policy also supports continued research into the genetic control of blood pressure and the development of genomic-based tools to assist physicians in better predicting risk and targeting therapy for hypertension.
Through its Improving Health Outcomes initiative, the AMA is making strides in developing and testing evidence-based recommendations to improve high blood pressure, including creating standardized checklists and other tools to measure blood pressure accurately.
Physicians and care teams in Maryland and Illinois are working with the AMA and researchers at the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities to make clinical changes around blood pressure management. They’re also exploring clinical-community linkages, in which physicians refer patients to community resources that can help them improve their blood pressure.
