Innovative study shows potential for personalised blood pressure treatment

There is large variation in how patients with hypertension respond to different blood pressure lowering drugs, according to a new study which highlights the potential for personalised treatment of high blood pressure.

Results from the Precision Hypertension Care Study (PHYSIC) – published in JAMA – indicate that personalised treatment could lead to an average reduction in systolic blood pressure of 4.4 mm Hg compared with a fixed treatment choice.

The study, from researchers at Uppsala University in Sweden, The George Institute for Global Health in Australia, and Uppsala Clinical Research Center, addresses a key question which has been whether tailoring drug choice to individual patients can make a difference.

The research team for PHYSIC tested four different BP lowering medicines in 280 people with hypertension in Sweden. They found that the benefit for individuals varied according to the medication given.

For many people, matching the right treatment to the right individual was better than doubling the dose of a non-tailored drug and almost as good as adding a second drug.

At present, it is not possible to predict in advance which medication is best for a patient, but the study indicates what may be possible in future in terms of personalised treatment if the ‘right’ drug for a patient can be predicted.

Professor Bruce Neal, Executive Director for The George Institute for Global Health, Australia, a co-author on the research, and a member of the ISH, said: “Personally tailored treatment is now the standard of care for many patients with cancer, but personalised medicine has been much slower to take off in the cardiovascular field. This research shows that there is real potential for tailoring something as simple as blood pressure lowering treatment.

“The next challenge we need to overcome is how to do this at scale. Although we showed the potential in this research study, we don’t yet have the tools to do it in practice.’’

Principal investigator of the study Johan Sundström, Professor of Epidemiology at Uppsala University and Conjoint Professor at The George Institute said: “With these findings, we have evidence that existing blood pressure treatments can be optimised for maximum patient benefit. Personalised treatment may reduce the need for higher doses and multiple medications, with the potential to improve treatment adherence, patient outcomes, and cost efficacy.”

President of the International Society of Hypertension (ISH), Professor Bryan Williams, said:

“We have known about heterogeneity in response to individual types of blood pressure medications for years. That is one of the reasons why guidelines now recommend commencing treatment in most patients with two medications, which will always produce better blood pressure lowering than the best response to a single drug, and will do this in everybody.”

Read the study in JAMA – Heterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs.

In a separate study involving Professor Neal just published in Nature Medicine, a research team found that using potassium-enriched salt instead of regular salt lowered blood pressure in older people and reduced their risk of cardiovascular events.

The study involved 48 residential elderly care facilities in China with a total of 1,612 participants who were 55 or older.

Professor Neal told New Scientist: “If everyone switched from regular salt to potassium-enriched salt, we could prevent millions of premature strokes and heart attacks around the world each year.”