Personalized medicine—a modern approach for the diagnosis and management of hypertension

Abstract

The main goal of treating hypertension is to reduce blood pressure to physiological levels and thereby prevent risk of cardiovascular disease and hypertension-associated target organ damage. Despite reductions in major risk factors and the availability of a plethora of effective antihypertensive drugs, the control of blood pressure to target values is still poor due to multiple factors including apparent drug resistance and lack of adherence. An explanation for this problem is related to the current reductionist and ‘trial-and-error’ approach in the management of hypertension, as we may oversimplify the complex nature of the disease and not pay enough attention to the heterogeneity of the pathophysiology and clinical presentation of the disorder. Taking into account specific risk factors, genetic phenotype, pharmacokinetic characteristics, and other particular features unique to each patient, would allow a personalized approach to managing the disease. Personalized medicine therefore represents the tailoring of medical approach and treatment to the individual characteristics of each patient and is expected to become the paradigm of future healthcare. The advancement of systems biology research and the rapid development of high-throughput technologies, as well as the characterization of different –omics, have contributed to a shift in modern biological and medical research from traditional hypothesis-driven designs toward data-driven studies and have facilitated the evolution of personalized or precision medicine for chronic diseases such as hypertension.

Decision Support for Re-Designed Medicinal Products - Assessing Consequences of a Customizable Product Design on the Value Chain from a Sustainability Perspective

“…A CPC, based on the assumption that a reduction in material processing is expected, may lead to a reduction of emissions, wastes and water consumption (Unger, 2013;Sheldon, 2016). The social dimension may be associated with workplace challenges in the form of risks for chemical exposure and repetitive work for the TPC (Segawa et al, 2016;Savoia et al, 2017), and no change can be expected for the CPC. The economic dimension is associated with costs for material and operations for the TPC, and increased costs may be expected due to the need of investments in new technology and additional assembly process, and adjustment of information on packages.…”

Pharmacogenetic implications in the management of metabolic diseases in Brazilian populations

“…Hypertension is a very important public health issue, because it affects about one billion adult globally and is the most important risk factor to causa mortis in the contemporary society: coronary artery diseases, stroke, renal dysfunction and heart failure (Savoia et al, 2017).…”

“…A small subset of the hypertensive population is affected by monogenic disease; however the majority of cases of hypertension are multifactorial and polygenic. There is a complex trait of etiology involving an intricate network between homeostasis of extracellular body fluid, vascular tone regulated by renal system, cardiac contractility, neuroendocrine system and others factors such as age, weight, ethnicity, lifestyle and diet (Savoia et al, 2017).…”

“…Currently, the most commonly used antihypertensives are: (i) angiotensin I-converting enzyme (ACE) inhibitors, such as enalapril; (ii) angiotensin II-receptor blockers (ARBs), such as losartan; (iii) β-blockers, for example, atenolol; (iv) calcium-channel blockers, such as nifedipine; and (v) diuretics, such as spironolactone or hydrochlorothiazide. Even though these antihypertensive drugs are effective and well tolerated, only about half of patients with treated hypertension achieve appropriate BP control (Savoia et al, 2017). This variability is caused by genetic and non-genetic factors, which are known can cause primary and secondary hypertension (Cooper-DeHoff, Johnson, 2016).…”

Genetic Research: The Role of Citizens, Public Health and International Stakeholders

“…possibility that may occur. It is easy to obtain, and can be of interest to third parties [2] such as family members, insurance companies and employers.Therefore, there is great interest in this information, especially since genetic predisposition has been clearly demonstrated for various diseases such as cardiovascular pathologies [3,4] diabetes [5], late onset Alzheimer [6], schizophrenia [7]…”