Pharmacogenomics-Guided Therapy Improved Short-Term Blood Pressure Control

Pharmacogenomics-guided antihypertensive therapy produced greater 4-week blood pressure reductions than standard care in a randomized, open-label trial published in Frontiers in Cardiovascular Medicine. The authors cautioned that the results represent short-term efficacy under intensive management rather than expected long-term benefit in routine practice.

Investigators enrolled 2,702 adults with essential hypertension at 14 hospitals in Hunan Province, China, from 2021 through 2024. Participants were randomized 1:1 to standard care or medication selection informed by testing of 7 gene loci associated with 5 antihypertensive drug classes. The primary outcome was change in office blood pressure after 4 weeks. All participants had uncontrolled blood pressure at enrollment.

Mean blood pressure decreased from 155.45/92.12mmHg to 129.03/76.96mmHg with pharmacogenomics-guided therapy and from 156.52/91.75mmHg to 143.74/82.73mmHg with standard care. Median systolic and diastolic reductions were 27 and 15mmHg, respectively, in the guided-therapy group and 10 and 8mmHg in the control group; both between-group differences were significant (P<.001).

At 4 weeks, 87.1% of patients in the guided-therapy group and 21.9% in the control group achieved seated office blood pressure below 140/90mmHg (P<.001). Four patients receiving guided therapy reported adverse events, compared with none receiving standard care; overall and individual adverse-event rates did not differ significantly, and no serious adverse events occurred.

Important limitations included the open-label design, 4-week follow-up, and a baseline imbalance in untreated patients: 28.5% in the guided-therapy group versus 11.6% in the control group. Investigators said these factors may have inflated the observed blood pressure differences, although the control-rate difference persisted after covariate adjustment.

Source: Wu S, Liu W, Chen L, et al. Pharmacogenomics-guided therapy for essential hypertension: a multi-center randomized controlled open-label trial. Front Cardiovasc Med. 2026;13:1842597. doi:10.3389/fcvm.2026.1842597