Genetic and social factors in blood pressure control in hypertensives

高血压影响美国5000多万人，是老年人最常见的疾病 哪些成年人会寻求医疗救治。关于高血压认知、治疗和控制的研究 族裔群体表明，非洲裔美国人和西班牙裔社区内存在着显著的差异。 与非西班牙裔白人相比。具体地说，需要做出更大的努力来具体预防和治疗 非裔美国人中的高血压。而西班牙裔美国人的高血压患病率较低 在社区，他们接受治疗的血压比可比的白人人口高。为了更好地 了解高血压患者降压治疗中影响血压控制的因素， 我们正在利用一大批高血压患者及其同胞，他们有广泛的临床，社会， 来自动脉病遗传流行病学网络(热那亚)研究的行为和遗传数据。 众所周知，高血压患者对降压治疗的反应是不同的，通常需要 服用多种药物来降低他们的血压。这种异质性反映了各种各样的因素， 影响药物动力学的个体间差异(即药物吸收、分布、 代谢或排泄)或药效学(即相关的生化和生理机制 与药物靶标)药物的性质。其他因素包括人口统计、家庭影响、 社会经济因素和生活方式因素预计也会影响血压治疗和 高血压患者的控制力。尽管这种异质性早已被确立，但人们对此知之甚少。 关于影响血液中种族差异的特定社会、行为和遗传关联 对降压药的压力反应。我们建议全面调查这些物质的来源 高血压患者的血压水平在普通临床人群中的变化反映了广泛的 各种可能的原因，从社会人口和生活方式的影响(目标1)，他们的 与高血压病程和治疗方案的分布有关(目标2)，风险的影响 逐个基因、逐个基因、逐个药物或逐个风险因素相互作用(目标3)，以预测5年内 血压(目标4)。

Hypertension affects more than 50 million people in the United States and is the most common disease for which adults seek medical attention. Studies of hypertension awareness, treatment, and control across ethnic groups indicate that significant disparities exist within the African-American and Hispanic communities compared to non-Hispanic Whites. Specifically, greater efforts are needed specifically to prevent and treat high blood pressure among African-Americans. While the prevalence of hypertension is lower in Hispanic communities, they have higher treated blood pressure than comparable White populations. To better understand the factors that effect control of blood pressure in hypertensives on antihypertensive therapies, we are taking advantage of a large cohort of hypertensives and their sibs with extensive clinical, social, behavioral, and genetic data from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. It is well known that hypertensives respond heterogeneously to anti-hypertensive therapies, often requiring multiple medications to lower their blood pressure. This heterogeneity reflects a wide variety of factors that influence interindividual variation in the pharmacokinetic (i.e. mechanisms of drug absorption, distribution, metabolism, or excretion) or pharmacodynamic (i.e. biochemical and physiological mechanisms associated with the drug target) properties of a drug. Other factors including demographic, familial influences, socioeconomic factors and lifestyle factors are also expected to influence blood pressure treatment and control in hypertensives. Although this heterogeneity has long been established, relatively little is known about the specific social, behavioral, and genetic associations that influence ethnic variation in blood pressure response to anti-hypertensive drugs. We propose to comprehensively investigate the sources of variation in blood pressure levels in hypertensives from the general clinical population that reflect the wide spectrum of possible causes ranging from socio-demographic and lifestyle influences (Aim 1), their association with the distribution of hypertension duration and treatment regimes (Aim 2), the impact of risk factor-by-gene, gene-by-drug, or drug-by-risk factor interactions (Aim 3) in order to predict 5-year changes in blood pressure (Aim 4).