Association of the genetic ancestry with resistant hypertension in the ReHOT (Resistant Hypertension Optimal Treatment) randomized study

Abstract

Resistant hypertension (RH) is defined as uncontrolled blood pressure despite treatment with three or more antihypertensive medications, including, if tolerated, a diuretic in adequate doses. it has been widely known that race is associated with blood pressure control. However, intense debate persists as to whether this is solely explained by unadjusted socioeconomical variables or genetic variation. in this scenario, the main aim was to evaluate the association between genetic ancestry and resistant hypertension in a large sample from a multicenter trial of stage ii hypertension, the ReHot study. Samples from 1,358 patients were analyzed, of which 167 were defined as resistant hypertensive. Genetic ancestry was defined using a panel of 192 polymorphic markers. The genetic ancestry was similar in resistant (52.0% European, 36.7% African and 11.3% Amerindian) and nonresistant hypertensive patients (54.0% European, 34.4% African and 11.6% Amerindian) (p > 0.05). However, we observed a statistically suggestive association of African ancestry with resistant hypertension in brown patient group. in conclusion, increased African genetic ancestry was not associated with RH in Brazilian patients from a prospective randomized hypertension clinical trial.likely to be black 8 . Some variables, such as advanced age, increased body mass index, male gender, genetic variants and others chronic diseases were also associated with RH or uncontrolled hypertension [28][29][30][31] .On the other hand, some studies, including the present study, did not find an association of self-reported race/ color with RH. A study with 9,361 hypertensive patients from the US, did not find differences in RH proportions according to race 32 . In addition, a meta-analysis, which analyzed the global prevalence of RH from data of 3.2 million patients, did not observe differences 33 . Some studies have observed genetic variants associated with risk for resistant hypertension 2,34,35 . However, to the best of our knowledge, studies of genetic ancestry and RH are not identified in the literature. Our hypothesis was that an increased proportion of African ancestry might be a risk factor for RH, in the overall group or even in subgroups among self-declared race/color, but this was not confirmed. However, in brown patient group, we identified a statistically suggestive association of African ancestry with resistant hypertension. This statistically suggestive association suggests that the criteria applied to segregate the race/color groups, according Brazilian Institute of Geography and Statistics, are possibly distorting the real distribution and, at least in part, leading a limitation for dividing into homogeneous groups. Thus, further investigations and new hypothesis should be tested to elucidate possible associations.The prevalence and incidence of RH will grow considerably because there is a large number of overweight/ obese individuals 36 . In addition, the cutoff blood pressure criteria for RH was reduced from 140/90 mmHg to < 130/80 mmHg 9 . Thus, prev...

Current Knowledge about the New Drug Firibastat in Arterial Hypertension

“…The clinical trials showed that there were no severe adverse effects, and that firibastat is effective in lowering BP [4,44,[48][49][50]. In addition, it was found that firibastat has a successful BP-lowering effect in blacks, who generally struggle with resistant hyper-tension to standard treatment [44,61].…”