A pharmacogenomics‐guided antihypertensive strategy for blood pressure reduction in rural China: a cluster‐randomized controlled trial
File(s)
Author(s)
Type
Journal Article
Abstract
Background
Although pharmacogenomics can effectively guide antihypertensive treatment, relevant evidence from low‑resource primary care settings is lacking. The aim of this study is to evaluate a pharmacogenomic‑guided antihypertensive strategy in real‑world, low‑resource primary care settings.
Methods
We randomly assigned 94 villages (in 1:1:1 ratio, with stratification by villages) to receive a multifaceted intervention that included follow-up, health education, and medication adjustment guided by pharmacogenomics (treatment) or physician's experience (control), or routine care (observation) over 4 weeks. The primary outcome was the proportion of patients with controlled blood pressure after 4 weeks of treatment. Generalized linear, linear mixed-effect regression, and sensitivity analysis were conducted to assess the difference among groups. The intracluster correlation coefficient was calculated to assess the heterogeneity with cluster.
Results
This study included 1031 hypertensive patients from 90 villages of Dajie and Jiuzhi towns in Daming County from May 10 to December 31, 2022. Overall, 79 loci on 39 antihypertensive-related genes were tested for patients in the treatment group. After 4 weeks of treatment, 371 of 377 (98.4%) patients in the treatment group, 256 of 345 (74.2%) patients in the control group, and 232 of 309 (75.1%) patients in the observation group had their blood pressure under control. The between-group net differences were 24.2% (95% confidence interval [CI]: 19.4%–29.0%) and 23.3% (95% CI: 18.3%–28.3%) for the treatment versus control groups and treatment versus observation groups, respectively. After 4 weeks of treatment, the proportion of patients with overall incident adverse events was no different among the three groups (all p > 0.05), and no serious adverse events or deaths related to antihypertensive treatment were reported during the study period.
Conclusions
A pharmacogenomic-guided antihypertensive strategy can significantly enhance blood pressure control while maintaining a similar safety level compared to an experience-guided antihypertensive strategy in low-resource, primary care settings.
Although pharmacogenomics can effectively guide antihypertensive treatment, relevant evidence from low‑resource primary care settings is lacking. The aim of this study is to evaluate a pharmacogenomic‑guided antihypertensive strategy in real‑world, low‑resource primary care settings.
Methods
We randomly assigned 94 villages (in 1:1:1 ratio, with stratification by villages) to receive a multifaceted intervention that included follow-up, health education, and medication adjustment guided by pharmacogenomics (treatment) or physician's experience (control), or routine care (observation) over 4 weeks. The primary outcome was the proportion of patients with controlled blood pressure after 4 weeks of treatment. Generalized linear, linear mixed-effect regression, and sensitivity analysis were conducted to assess the difference among groups. The intracluster correlation coefficient was calculated to assess the heterogeneity with cluster.
Results
This study included 1031 hypertensive patients from 90 villages of Dajie and Jiuzhi towns in Daming County from May 10 to December 31, 2022. Overall, 79 loci on 39 antihypertensive-related genes were tested for patients in the treatment group. After 4 weeks of treatment, 371 of 377 (98.4%) patients in the treatment group, 256 of 345 (74.2%) patients in the control group, and 232 of 309 (75.1%) patients in the observation group had their blood pressure under control. The between-group net differences were 24.2% (95% confidence interval [CI]: 19.4%–29.0%) and 23.3% (95% CI: 18.3%–28.3%) for the treatment versus control groups and treatment versus observation groups, respectively. After 4 weeks of treatment, the proportion of patients with overall incident adverse events was no different among the three groups (all p > 0.05), and no serious adverse events or deaths related to antihypertensive treatment were reported during the study period.
Conclusions
A pharmacogenomic-guided antihypertensive strategy can significantly enhance blood pressure control while maintaining a similar safety level compared to an experience-guided antihypertensive strategy in low-resource, primary care settings.
Date Issued
2026-06-10
Date Acceptance
2026-04-30
Citation
Health Care Science, 2026
ISSN
2771-1749
Publisher
Wiley
Journal / Book Title
Health Care Science
Copyright Statement
© 2026 The Author(s). Health Care Science published by John Wiley & Sons Ltd on behalf of Tsinghua University Press. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
License URL
Publication Status
Published online
Date Publish Online
2026-06-10