A paper recently published in Endocrine Reviews concludes that primary hypertension is not a disease but rather a syndrome, and that genetics may hold the key to targeted and individualized treatment.
The review, by Worapaka Manosroi, MD, and Gordon H. Williams, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, points out that hypertension is the leading contributing factor to all-cause mortality, being the main risk factor for stroke and coronary artery disease. Manosroi and Williams write that the individual causes of hypertension – the diseases – share a common sign: elevated blood pressure. This has caused an increase in genetic tools to determine these causes. “Substantial pre-clinical and clinical data have documented that an increased blood pressure and its accompanying substantial cardiovascular risks are largely secondary to the interplay between genetics and environment,” the authors write.
The researchers reviewed studies through online search of National Library of Medicine using the PubMed search engine from January 2004 through December 2017, using the search terms, “genes, genetics, polymorphism with hypertension, blood pressure, salt sensitivity and salt sensitive blood pressure.” They identified 62 genes as potential candidates for this review, but only 21 met the criteria to be included: “two supporting cohorts from different publications or two different cohorts within a single publication or a single positive cohort with a confirmatory genetically modified animal study.”
Of those 21 genes, 18 were associated with salt-sensitive hypertension. “[E]ighteen of the twenty-one genes support the posit that polymorphic variants in a gene alone were insufficient to produce a level of blood pressure high enough to be called hypertension,” the authors write. “Gene variants and an appropriate environment (usually liberal salt intake) were required. These eighteen genes were associated with a proximate phenotype that included SSBP and therefore, salt sensitive hypertension.”
The review covers a lot more, but points out that “these 18 genotype/phenotype groups are associated with nearly 50% of the primary hypertension population, suggesting that precise mechanistically driven treatment/prevention strategies for the individual primary hypertension phenotypes are feasible in the near term.”