The effect of the M235T polymorphism of the angiotensinogen gene on the office blood pressure during therapy with angiotensin II receptor blockers

Aim. To study the pharmacodynamic parameters of the effectiveness of therapy with angiotensin II receptor blockers in the form of monotherapy and as part of combination drugs in patients with hypertension, depending on the genetic characteristics of patients — the M235T polymorphism of the angiotensinogen gene (AGT).
Material and methods. The study included 179 patients in the Moscow region with newly diagnosed hypertension of 1-2 degrees, among whom 141 (78.8%) women and 38 (21.2%) men aged 32 to 69 years, who were randomly assigned to irbesartan and valsartan groups in the form of mono- or combination therapy with hydrochlorothiazide by a simple randomization method. After 3 weeks of pharmacotherapy, the presence of rs699 (C4072T, M235T) genetic polymorphism of the AGT was determined.
Results. Homozygotes СС with the genetic polymorphism M235T of the AGT treated with valsartan had a statistically significantly higher frequency of achieving target blood pressure figures after 3 weeks of pharmacotherapy compared with TT homozygotes (p=0.006) and a statistically significantly lower frequency of the need to increase the dose of the drug compared with heterozygotes and TT homozygotes (p=0.047 and 0.006, respectively). Among patients treated with irbesartan, there was no statistically significant association of the M235T polymorphism genotype of the AGT with these indicators.
Conclusion. The data obtained may indicate a faster and more stable antihypertensive effect in homozygotes of CC and TT of the genetic polymorphism M235T of the AGT. When personalizing hypertension therapy for patients of the Moscow region, carriers of homozygous CC and TT genotypes of the M235T genetic polymorphism of the AGT for more effective achievement of target blood pressure figures, it is advisable to recommend valsartan as a starting therapy in the form of mono- or twocomponent therapy, depending on the degree of hypertension.

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