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J. Pers. Med. 2018, 8(2), 16; https://doi.org/10.3390/jpm8020016

Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations

1
Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
2
Cecil R. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
3
McAllister Heart Institute at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
4
Q2 Solutions|EA Genomics, Morrisville, North Carolina. 27560, USA
5
Department of Family Medicine, East Carolina University, Greenville, NC 27834, USA
6
Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
7
Center for Health Promotion and Disease Prevention at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
8
Department of Nutrition, Gillings School of Global Public Health at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
9
Presbyterian Hospital/Weill-Cornell Medical Center, New York, NY 10065, USA
10
Department of Pharmacology and Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Those authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Received: 11 January 2018 / Revised: 23 March 2018 / Accepted: 23 April 2018 / Published: 30 April 2018
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Abstract

As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: (i) to determine if single nucleotide polymorphisms (SNPs) that associate with blood pressure variation, identified in large studies, are applicable to blood pressure control in subjects from a rural population; (ii) to measure the association of these SNPs with subjects’ responsiveness to the hypertension intervention; and (iii) to identify other SNPs that may help understand patient-specific responses to an intervention. We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP) or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA) and Caucasian Americans (CAU). Of the 48 candidate SNPs, 13 SNPs associated with baseline SBP in our study; however, one candidate SNP, rs592582, also associated with a change in SBP after one year. Using our study data, we identified 4 and 15 additional loci that associated with a change in SBP in the AA and CAU groups, respectively. Our analysis of gene-age interactions identified genotypes associated with SBP improvement within different age groups of our populations. Moreover, our integrative analysis identified AQP4-AS1 and PADI2 as genes whose expression levels may contribute to the pleiotropy of complex traits involved in cardiovascular health and blood pressure regulation in response to an intervention targeting hypertension. In conclusion, the identification of SNPs associated with the success of a hypertension treatment intervention suggests that genetic factors in combination with age may contribute to an individual’s success in lowering SBP. If these findings prove to be applicable to other populations, the use of this genetic variation in making patient-specific interventions may help providers with making decisions to improve patient outcomes. Further investigation is required to determine the role of this genetic variance with respect to the management of hypertension such that more precise treatment recommendations may be made in the future as part of personalized medicine. View Full-Text
Keywords: hypertension; GWAS; precision medicine; rural population; SNP-age interaction hypertension; GWAS; precision medicine; rural population; SNP-age interaction
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Halladay, J.R.; Lenhart, K.C.; Robasky, K.; Jones, W.; Homan, W.F.; Cummings, D.M.; Cené, C.W.; Hinderliter, A.L.; Miller, C.L.; Donahue, K.E.; Garcia, B.A.; Keyserling, T.C.; Ammerman, A.S.; Patterson, C.; DeWalt, D.A.; Johnston, L.F.; Willis, M.S.; Schisler, J.C. Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations. J. Pers. Med. 2018, 8, 16.

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