Genetic and social factors in blood pressure control in hypertensives

在美国，高血压影响超过5000万人，并且是糖尿病患者中最常见的疾病。 成年人寻求医疗照顾。高血压的认识、治疗和控制研究 种族群体表明，在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。具体而言，需要加大力度，专门预防和治疗 非裔美国人的高血压西班牙裔高血压患病率较低， 在社区中，他们的治疗血压高于可比的白色人群。更好地 了解影响高血压患者血压控制的降压治疗因素， 我们正在利用大量高血压患者及其同胞的临床，社会， 来自动脉病遗传流行病学网络（GENOA）研究的行为和遗传数据。 众所周知，高血压患者对抗高血压治疗的反应不均匀，通常需要 多种药物来降低血压。这种异质性反映了多种因素， 影响药代动力学（即药物吸收，分布， 代谢或排泄）或药效学（即与代谢或排泄相关的生物化学和生理学机制）。 与药物靶标）药物的性质。其他因素包括人口统计学，家庭影响， 社会经济因素和生活方式因素也会影响血压治疗， 控制高血压。虽然这种异质性早已确立，但相对而言知之甚少 关于影响血液中种族差异的特定社会，行为和遗传协会 抗高血压药物的压力反应。我们建议全面调查 高血压患者的血压水平与一般临床人群的差异， 一系列可能的原因，包括社会人口和生活方式的影响（目标1）， 与高血压持续时间和治疗方案的分布相关（目的2），风险的影响 因素与基因、基因与药物或药物与风险因素的相互作用（目的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).