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Endocrine, Metabolic & Immune Disorders - Drug Targets

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ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

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Review Article

Pharmacogenomics of Antihypertensive Drugs in Brazil: Recent Progress and Clinical Implications

Author(s): Fabiana Dalla Vecchia Genvigir*, Carolina Dagli-Hernandez, Thiago Dominguez Crespo Hirata, Yitian Zhou, Volker M. Lauschke, Mario Hiroyuki Hirata and Rosario Dominguez Crespo Hirata

Volume 22, Issue 13, 2022

Published on: 18 April, 2022

Page: [1263 - 1275] Pages: 13

DOI: 10.2174/1871530322666211222122212

Price: $65

Abstract

Background: The available antihypertensive drugs are effective and well tolerated agents. However, only about half of patients with treated hypertension achieve appropriate blood pressure control. Genetic and non-genetic factors contribute to the interindividual variability of the therapeutic response.

Objective: This review constitutes a comprehensive update of the pharmacogenomics of antihypertensive drugs and their clinical implications in Brazil.

Results: Twenty-five studies explored the influence of gene variants on drug response in patients with primary, resistant, or gestational hypertension. Variants in BDKRB2, NOS3, PRKCA, and VEGFA influenced the response to enalapril in patients with primary hypertension. AGT and MMP2 variants were associated with a high risk of resistance to antihypertensive treatment, whereas NOS2 variants were related to low risk. Moreover, NAT2 slow acetylators showed an increased response to hydralazine in patients with resistant hypertension. HMOX1, NAMPT, MMP9, NOS3, and TIMP1 variants might be markers of drug responsiveness in hypertensive or preeclamptic pregnant women. Power and replication of studies, polygenic nature of the response to therapy, and treatment with multiple drugs were important challenges to identify genetic predictors of antihypertensive response in Brazil.

Conclusion: Pharmacogenomic studies in Brazilian cohorts provide some evidence of variants, mainly in pharmacodynamics genes, which influence the response to antihypertensive drugs. However, some findings are limited by cohort size or therapeutic scheme and may be influenced by interactions with other genetic and non-genetic factors. Therefore, further investigations are needed to elucidate the contribution of pharmacogenomics to the efficacy and safety of antihypertensive therapy.

Keywords: Antihypertensive drugs, gestational hypertension, pharmacogenomics, primary hypertension, resistant hypertension, Brazilian, gene variants.

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