Materson Barry J
Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
Am J Med. 2007 Apr;120(4 Suppl 1):S10-20. doi: 10.1016/j.amjmed.2007.02.003.
Heterogeneity of treatment effects (HTE) is a measure of the variations in individual treatment response to the same agent across a population. Hypertension affords an appropriate model for investigators of HTE. Use of blood pressure measurement guidelines and consistent techniques help to reduce the potential variability associated with clinician measurements. Patient characteristics such as age and race/ethnicity can affect blood pressure, including patient response and adverse events observed with antihypertensive medication. Through pharmacogenetic advances, potential underlying causes for such variation are emerging. The growing number of clinical examples of mutations that affect antihypertensive response includes multiple polymorphisms within the components of the renin-angiotensin-aldosterone system. The most prominent examples of these polymorphisms exist in the genes coding for angiotensinogen, angiotensin-converting enzyme, and the angiotensin II type 1 receptor. An understanding of the components of blood pressure variability and sources of HTE in antihypertensive therapy is important for analyzing published reports on this topic. It is also helpful when designing treatment protocols for individual patients with hypertension and in assessing their response to therapy.
治疗效果异质性（HTE）是衡量同一药物在人群中个体治疗反应差异的指标。高血压为HTE研究者提供了一个合适的模型。使用血压测量指南和一致的技术有助于减少与临床医生测量相关的潜在变异性。年龄和种族/民族等患者特征会影响血压，包括患者反应以及使用抗高血压药物时观察到的不良事件。随着药物遗传学的进展，这种变异的潜在根本原因正在显现。影响抗高血压反应的突变的临床实例越来越多，包括肾素-血管紧张素-醛固酮系统各组分内的多种多态性。这些多态性最突出的例子存在于编码血管紧张素原、血管紧张素转换酶和血管紧张素II 1型受体的基因中。了解抗高血压治疗中血压变异性的组成部分和HTE的来源对于分析关于该主题的已发表报告很重要。在为个体高血压患者设计治疗方案以及评估他们对治疗的反应时也很有帮助。
