Is there an optimal blood pressure drug for every person?

The number of people with hypertension has doubled, and around a third of adults aged 30–79 have the condition — 1.28 billion people worldwide. Untreated hypertension can lead to kidney disease, heart disease and stroke, accounting for 11.3 million deaths in 2021 alone.

Only a small minority of patients get their blood pressure under control with drug therapy. A part of the problem may be that the efficacy of treatments differs between individuals. A key question is whether tailoring drug choice to the individuals can make a difference.

To address this question, the Precision Hypertension Care Study (PHYSIC) sequentially tested four different blood pressure lowering medicines in 280 people with hypertension in Sweden. The study showed that the benefit for individuals varied according to the medication given.

For many people, matching the right treatment to the right individual was better than doubling the dose of a non-tailored drug and almost as good as adding a second drug.

Principal investigator Johan Sundström, Professor of Epidemiology at Uppsala University and Conjoint Professor at The George Institute for Global Health, said, “With these findings, we have evidence that existing blood pressure treatments can be optimised for maximum patient benefit. Personalised treatment may reduce the need for higher doses and multiple medications, with the potential to improve treatment adherence, patient outcomes and cost efficacy.”

The PHYSIC trial sets the groundwork for further research into personalised medicine to treat hypertension. Professor Bruce Neal, Executive Director for The George Institute, Australia and a co-author on the research, said, “Personally tailored treatment is now the standard of care for many patients with cancer, but personalised medicine has been much slower to take off in the cardiovascular field. This research shows that there is real potential for tailoring something as simple as blood pressure lowering treatment.”

However, he added, “The next challenge we need to overcome is how to do this at scale. Although we showed the potential in this research study, we don’t yet have the tools to do it in practice.” The results were published in the Journal of the American Medical Association (JAMA).

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