The effect of genetic polymorphisms, drug-disease and drug-drug interactions on hypertension control in Egyptian patients

Background: There is a clear decrease in the control rates of high blood pressure in Egyptian patients, so it is necessary to reveal the hidden causes responsible for this problem through extensive studies of these reasons. The prevalence of resistant hypertension among adults with treated hypertension ranged from 34% to 39%. African descent ethnic groups are more likely to develop hypertension and the organ damage that goes along with it at younger ages. They are also more likely to have kidney disease, stroke, heart failure, and mortality. Angiotensin-converting enzyme-2 rs2106809 is a significant predictor of the response to antihypertensive treatment with Angiotensin-converting enzyme inhibitors. The purpose of this study was to determine the genetic and clinical factors that may contribute to resistance hypertension in Egyptian patients through detecting the drug-drug and drug-disease (hypertension) interactions, together with the relationship between Angiotensin-converting enzyme -2 rs2106809 genetic variations and the antihypertensive effects of 31 antihypertensive medications from many pharmacological categories. Methods: Patients received a total of 306 antihypertensive medications. All patients’ medical records were reviewed to detect all patients’ medications, comorbidities and other patients’ characteristics (age, sex, body weight, electrolytes, fasting blood sugar levels, lipid profiles and cardiac and kidney function tests) that may affect blood pressure control. Results: A total of 306 patients (68 males and 238 females) who attended Kasr Alainy Rheumatology Outpatient Clinic were enrolled in the study, they received 31 antihypertensive medications. There was a statistically significant difference between the different genotypes and blood pressure control. All detected drug – drug interactions were recorded and a total of 235 drug interactions were discovered. The detected drug – drug interactions were classified as interactions that increase the antihypertensive effect (90 types) or interactions that decrease the antihypertensive effect (224 types). Almost all patients (99.7%) received drugs that decrease blood pressure while about 57% of patients received drugs that increase blood pressure. All factors that may affect blood pressure control were detected and there was a statistically significant difference between the different genotypes and the number of drugs increasing blood pressure and serum calcium levels. Conclusions: Previous studies were focused on age, higher baseline blood pressure, obesity, excessive salt intake, diabetes, left ventricular hypertrophy, black race, female sex, and measurements of the renin–angiotensin–aldosterone system as the main causes of interindividual variabilities. This study documented that drug – drug, drug – disease interactions and different genetic polymorphisms are more serious and important causes for these variabilities.