RESUMEN
Pharmacogenomics is increasingly moving into mainstream clinical practice. Careful consideration must be paid to inclusion of diverse populations in research, translation and implementation, in the historical and social context of population stratification, to ensure that this leads to improvements in healthcare for all rather than increased health disparities. This review takes a broad and critical approach to the current role of diversity in pharmacogenomics and addresses potential pitfalls in order to raise awareness for prescribers. It also emphasizes evidence gaps and suggests approaches that may minimize negative consequences and promote health equality.
Asunto(s)
Promoción de la Salud , Farmacogenética , HumanosRESUMEN
Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension. In this review, we discuss seven novel devices-renal nerve denervation, baroreflex activation therapy, carotid body ablation, central iliac arteriovenous anastomosis, deep brain stimulation, median nerve stimulation, and vagal nerve stimulation. We highlight how the devices differ, the varying degrees of evidence available to date and upcoming trials. This review also considers the possible factors that may enable appropriate device selection for different hypertension phenotypes.
Asunto(s)
Hipertensión/terapia , Antihipertensivos/uso terapéutico , Derivación Arteriovenosa Quirúrgica , Barorreflejo/fisiología , Presión Sanguínea/fisiología , Cuerpo Carotídeo/fisiopatología , Cuerpo Carotídeo/cirugía , Estimulación Encefálica Profunda , Terapia por Estimulación Eléctrica , Humanos , Hipertensión/fisiopatología , Arteria Ilíaca/cirugía , Vena Ilíaca/cirugía , Nervio Mediano/fisiopatología , Simpatectomía , Estimulación del Nervio VagoRESUMEN
At the dawn of the new decade, it is judicious to reflect on the boom of knowledge about polygenic risk for essential hypertension supplied by the wealth of genome-wide association studies. Hypertension continues to account for significant cardiovascular morbidity and mortality, with increasing prevalence anticipated. Here, we overview recent advances in the use of big data to understand polygenic hypertension, as well as opportunities for future innovation to translate this windfall of knowledge into clinical benefit.