Personalized treatment could be key to tackling uncontrolled high blood pressure

A widely used drug could be the key to treating many patients with uncontrolled high blood pressure, particularly for patients with a common gene variant, according to new research led by the University of Glasgow and published in the journal Hypertension.

In the British Heart Foundation (BHF) study, people with high blood pressure who had two copies of the variation experienced a 5% reduction in their average blood pressure after taking the drug torasemide for 16 weeks. The researchers say this change is likely to produce a substantial improvement in patients’ long-term cardiovascular health.

Torasemide is a drug used to treat fluid overload caused by many conditions, including heart failure, kidney disease and liver disease. Until now, loop diuretics like torasemide have not been commonly used to treat high blood pressure.

Patients with two copies of a common variation of the gene uromodulin—found in approximately two thirds of the population—saw a greater and more sustained fall in their blood pressure than patients with one or no copies. Previous research has linked this genetic variation to an increased risk of high blood pressure.

At least 11 million people in the U.K. have been diagnosed with high blood pressure, and although most receive effective treatment, blood pressure remains above healthy levels for as many as 3 million of them. High blood pressure, also known as hypertension, is linked to half of all heart and strokes in the UK and is estimated to cost the NHS over £2.1 billion every year.

This research offers hope that personalized blood pressure treatment based on a patient’s genetic profile could be key to helping people with uncontrolled hypertension nationwide.

Professor Sandosh Padmanabhan, Pontecorvo Chair of Pharmacogenomics at the University of Glasgow, who led the study, said, “These results highlight the exciting potential of a precision medicine approach in treating high blood pressure. By doing a simple genetic test using saliva or blood from the patient, we can predict how effectively this commonly used drug will control hypertension in individual patients.

“This approach will enable doctors to personalize treatment plans, greatly increasing the likelihood of success, especially for those who have faced challenges in managing their condition.”

In this trial, 174 participants from hospitals across Scotland with uncontrolled hypertension were treated with torasemide for 16 weeks. Blood pressure was measured at the start of the trial, after eight weeks, and after 16 weeks of treatment.

Genetic tests on saliva samples were used to determine how many copies of the variant participants had. The results showed 118 of the participants—just over two thirds—had two copies of the variation.

Average blood pressure fell for both groups after 16 weeks of treatment—by nearly 5% in the double variation group and 2.3% in those with single or no gene variation. The fall was more sustained and consistent in those with both copies of the variation, while the other group experienced a rebound in blood pressure after an initial drop.

Professor James Leiper, Associate Medical Director at the British Heart Foundation, said, “Uncontrolled hypertension is one of the biggest health problems we face in the U.K. It can lead to devastating complications like kidney failure, heart failure and vascular dementia. While there are many effective drugs to treat high blood pressure, they don’t work for everyone.

“This promising research has used the latest findings in genetic science to investigate how we could in future tailor treatment for many of these patients. Now larger trials are needed to confirm whether torasemide and other loop diuretics could be a significant new tool to combat uncontrolled hypertension in millions of people.”