Diuretics, thiazides, may not control your blood pressure, unless you have a genetic variation determining salt-sensitive hypertension. Controlling hypertension is important to reduce risk of heart attack and stroke
Controlling BP, the silent killer
About 58% of the population don’t respond to at least one class of anti-hypertensives. Thiazide diuretics are among the most popular of these drugs. Controlling blood pressure, known as the silent killer, is very important to avoid sudden heart attack and stroke. While people without the variant benefit from thiazide diuretics, such as hydrochlorothiazide, those with two variant copies may need other drugs, or combination therapy.
Targeted, better BP control
With normal genotype, people have a slight tendency to developing high blood pressure. But they will also benefit greatly from use of thiazide diuretics, such as hydrochlorothiazide. While predisposition to hypertension is lower with only one copy of the variant, studies indicate that they will also benefit from thiazide diuretics.
With two copies of the variant, patients may not benefit much from thiazide diuretics in controlling blood pressure. Alternative or additional drugs may be indicated.
Sodium reabsorption and thiazide diuretic response
Sodium reabsorption through epithelial sodium channels in the kidney is a major factor in controlling blood pressure. A variation in NEDD4L, an inhibitor of these channels, causes lower sodium reabsorption than normal. Since diuretics also exert their effect through lowering sodium levels, individuals with this genetic variation will benefit from antihypertensive medications with a different mechanism. In the absence of this variation, patients have up to 2-fold higher risk of hypertension.
The test classifies patient response to thiazide diuretics by genotyping the NEDD4L -404G>A using allele-specific real-time PCR. The method has almost 100% analytical accuracy and sensitivity. Patient’s relatives who are on thiazide diuretics are also recommended this test.
References
McDonough CW et al. 2013, Journal of Hypertension
Patrik SF et al. 2011, Journal of Hypertension