Doctors currently prescribe blood pressure drugs by trial and error, often cycling through several medications or combinations before finding one that works for a patient. This research aims to replace that guesswork with a genetic and metabolic test that predicts which drug—or which combination of drugs—will work best for a given individual, based on their ancestry and the chemical signatures in their blood. High blood pressure is the single biggest contributor to disease burden worldwide, yet in a large proportion of patients it remains poorly controlled. The problem is partly that response to treatment varies dramatically between ethnic groups and individuals, and doctors have no reliable way to match a patient to the right drug from the start. This project will test whether genetic markers of ancestry—which estimate the proportion of a person’s ancestors from Europe, Asia, and Africa—combined with detailed measurements of circulating metabolites, can predict the optimal drug or drug combination for each person. If successful, this could replace months of trial and error with a single, personalised prescription. For patients who need multiple drugs, the researchers also plan to use a new technology that combines them into one tablet, simplifying treatment. The approach could be applied both in the UK and in countries with different population ancestries, potentially improving blood pressure control on a global scale.
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High blood pressure (hypertension) is extremely common within the general population in the UK and worldwide and is a major cause of heart disease, kidney disease and stroke. It is recognised to be the single biggest contributor to the global burden of disease. In most people with hypertension, a healthy lifestyle alone is not enough to control blood pressure, and drug treatment is required. There are a wide variety of drugs available and although these are effective and safe, it is often necessary to try different types of drugs and often to use a combination of two or more drugs. Delay in choosing the right kind of tablet or combination of tablets through "trial and error" is a major problem and, in a large proportion of people with hypertension, blood pressure is not adequately controlled. Relatively little is known about why some people respond better to one kind of tablet or combination of tablets than others. It is know that response to treatment differs in different ethnic groups in the UK and may differ between populations in Europe, Asia and Africa. The objective of this research proposal is to determine if we can use genetic markers of ancestry (which predict the proportion of a person's ancestors from Europe, Asia and Africa) and a detailed measure of chemical "metabolites" circulating in the blood that characterise the biochemical processes in each person to predict the best type of drug or combination of drugs for that person. If a combination of drugs is required we can use a new technology to put these into a single tablet. We hope that this will provide a more effective simpler approach to single tablet treatment of hypertension both in the UK and in other countries.
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