药物遗传学是否使我们更接近于高血压初始药物治疗的“个体化医学”？
Has pharmacogenetics brought us closer to 'personalized medicine' for initial drug treatment of hypertension?
机构信息
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA.
出版信息
Curr Opin Cardiol. 2009 Jul;24(4):333-9. doi: 10.1097/HCO.0b013e32832c58ba.
PURPOSE OF REVIEW
To describe recent advances in antihypertensive pharmacogenetics and discuss challenges related to translating this knowledge into 'personalized medicine' for the initial drug treatment of hypertension.
RECENT FINDINGS
Recent studies included both prospective and retrospective analyses ranging from small clinical investigations of 42 participants to large, multicenter, randomized, outcome-based clinical trials of nearly 40 000 individuals. Treatment with drugs from five classes of antihypertensives was evaluated in these studies. The duration of treatment ranged from week-long follow up for blood pressure response to a decade-long follow up for clinical outcomes. In total, associations with 12 different candidate genes were assessed. These studies present the now familiar mixture of significant and nonsignificant pharmacogenetic findings that are sometimes consistent with, sometimes inconsistent with, previous findings in antihypertensive pharmacogenetics.
SUMMARY
Recent research in antihypertensive pharmacogenetics has added to the existing evidence base, and novel genes and variants as well as new methodologies are cause for continued optimism. However, translation of genomic science to clinical settings has not kept pace with growing interest in personalized medicine for hypertension. New research paradigms may be needed to translate pharmacogenetics into clinical tools. Clinical application will also require a trained clinical workforce, validated genetic tests, and payers willing to fund pretreatment testing.
目的综述
描述抗高血压药物遗传学的最新进展，并讨论将这些知识转化为高血压初始药物治疗的“个体化医学”所面临的挑战。
最新发现
最近的研究包括前瞻性和回顾性分析，研究对象从 42 名参与者的小型临床研究到近 40000 名个体的大型、多中心、随机、基于结局的临床试验不等。这些研究评估了五类抗高血压药物的治疗效果。治疗时间从血压反应的一周随访到临床结局的十年随访不等。总共评估了 12 个不同候选基因的相关性。这些研究呈现出目前常见的抗高血压药物遗传学中既有显著又有非显著的药物遗传学发现的混合情况，这些发现有时与以前的研究一致，有时则不一致。
总结
抗高血压药物遗传学的最新研究增加了现有证据基础，新的基因和变体以及新的方法值得持续乐观。然而，基因组科学向临床环境的转化并没有跟上人们对高血压个体化医学日益增长的兴趣。可能需要新的研究模式将药物遗传学转化为临床工具。临床应用还需要经过培训的临床工作人员、经过验证的基因检测以及愿意为预处理检测提供资金的支付方。
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