Optimisation of antihypertensive therapy based on pharmacogenetic data: a clinical case

In clinical practice, arterial hypertension often shows inadequate blood pressure control despite standard antihypertensive therapy. Genetically determined variability in pharmacokinetics and pharmacodynamics may contribute to interindividual differences in treatment efficacy and tolerability, yet it is rarely incorporated into routine prescribing. We report a clinical case of a 54-year-old female patient of Kyrgyz ethnic origin with uncontrolled blood pressure on combination therapy and an adverse reaction (peripheral edema) during amlodipine treatment. Pharmacogenetic testing revealed CYP2C9 *1/*3 (potentially reduced formation of the active losartan metabolite), CYP3A5 *3/*3 (a possible association with an increased risk of amlodipine-related adverse reactions), and CYP2D6 *10/*10 (a potential risk of dosedependent adverse reactions with certain beta-blockers). Therapy adjustment based on the obtained profile (switching from losartan to perindopril in combination with indapamide) was associated with achievement of target blood pressure levels without initiation of triple therapy. Pharmacogenetic information may be considered an additional tool to support antihypertensive therapy selection in selected patients.

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