Analysis of Clinical, Genetic and Gender Predictors of Ineffective Treatment of Hypertensive Patients
Background. Aldosterone as a key hormone of renin-angiotensin-aldosterone system plays an outstanding role in blood pressure regulation, arterial stiffness modulation and cardiovascular remodeling. Aldosterone synthase promoter region single-nucleotide polymorphism CYP11B2-344C/T affects serum aldosterone concentrations and modifies renin-aldosterone ratio. Yet is to identify whether this single-nucleotide polymorphism can be a predictor for response to antihypertensive treatment and specific marker for tailored antihypertensive medication.
Objective. Current study aimed to investigate the role of -344С/Т CYP11B2 polymorphism in combination with traditional cardiovascular risk factors, gender peculiarities of hypertension for antihypertensive treatment efficacy in hypertensive patients.
Patients and methods. 93 patients with different initial levels of blood pressure under the treatment were enrolled into the study. All patients underwent clinical evaluation according to current national standards; traditional cardiovascular risk factors were evaluated. Genetic material was obtained by buccal swab -344С/Т CYP11B2 genotyping was performed with polymerase chain reaction restriction fragment length polymorphism method.
Results. Groups of patients with different blood pressure control were comparable by age, average number of antihypertensive agents prescribed and type of used combination. In patients with poor blood pressure control rate of smoking and type 2 diabetes mellitus was significantly higher, comparing to the group with adequate control under treatment. Among patients with unachieved target blood pressure level T-monozygous allelic variant of -344С/ТCYP11B2 was detected in predominance, comparing to patients with proper treatment response.
Conclusions. Hypertensive patients have demonstrated markers, associated with lack of first line antihypertensive treatment efficacy. Among patients with high blood pressure under the treatment, rate of such risk factors as smoking and type 2 diabetes mellitus was higher, than in patients who received equivalent treatment and have shown proper blood pressure control. T-allele of CYP11B2 was associated with improper blood pressure control irrespective from the number of administered medications and the type of combination prescribed.
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