Precision Medicine A New Paradigm for Diagnosis and Management of Hypertension?

Hypertension is a disorder with significant global impact. With an overall prevalence of approximate to 40% in adults age 25 or older, hypertension accounts for 7.5 million deaths or 12.8% of total global deaths annually. Although the diagnosis and treatment of hypertension are seemingly straightforward, the lack of control is commonplace, with approximate to 40% of treated patients achieving blood pressure targets in the United States. 1 The reasons for failure to treat elevated blood pressure effectively are multifactorial and include drug intolerance, lack of adherence owing to the absence of symptoms or cost of drugs, physician inertia, and the mechanistic imprecision with which drug classes are chosen. Equally important is the fact that ( essential) hypertension is an excessively inclusive phenotype that oversimplifies complex biology and derivative physiology. To use a somewhat hyperbolic comparison, the diagnosis of essential hypertension is as uninformative and potentially therapeutically misleading as would be an overly inclusive diagnosis of tachycardia that fails to distinguish ventricular tachycardia from atrial fibrillation with rapid ventricular response. It should be no surprise, therefore, to recognize that the majority of patients are not well-served by current diagnostic and therapeutic paradigms for hypertension. Clearly, we need more nuanced phenotyping linked to genetically determined subgroup mechanisms that offer more specific, precise therapies to achieve optimal control of blood pressure and optimal morbidity and mortality benefit.