Genetic polymorphism and pharmacokinetics of antihypertensive drugs

The pharmacokinetic particularities of antihypertensive medicines are essential for the development of an appropriate dosing regimen to ensure the efficacy and safety of antihypertensive treatment. A key role in managing the pharmacokinetics of antihypertensive drugs is played by the genetic interindividual characteristics of patients, particularly the enzymes responsible for drug metabolism. It has been found that cytochrome P-450 isoenzymes (CYP2D6, CYP2C9, CYP2C19, CYP3A4/5, CYP1A1, CYP1A2, CYP2E1) are involved in the metabolism of beta-blockers, calcium channel blockers, angiotensin receptor blockers and diuretics. Genetic polymorphism of these enzymes can result in different metabolic phenotypes (slow, intermediate, normal, or ultrafast metabolizers), which can lead to the inactivation of the drug or the formation of active metabolites, ultimately influencing the efficacy and safety of treatment. The application of pharmacogenomic aspects of antihypertensive drugs in medical practice has led to the development of recommendations regarding the rational use of certain antihypertensive drugs (metoprolol, verapamil, amlodipine, hydrochlorothiazide, etc.). Personalizing treatment for patients with hypertension will improve treatment adherence, ensure adequate blood pressure control, reduce treatment costs, and enhance the quality of life.