Pharmacogenomics and precision medicine in hypertension

Hypertension is the main cause of worldwide cardiovascular deaths. This review combines recent developments in precision hypertension through genomic and proteomic and metabolomic analysis with biomarkers and digital health systems and artificial intelligence to achieve better detection and mechanism-based classification and personalized treatment plans. The combination of genomic discoveries about common polygenic risk and actionable pharmacogenetic variants such as ACE and AGTR1 and CYP2D6 and CYP3A5 enables healthcare providers to determine patient risk levels and choose appropriate medications. The combination of RAAS inhibitors with diuretics and β-blockers and calcium channel blockers becomes possible through proteomic and metabolomic signatures that reveal renin- or aldosterone-driven and salt-sensitive phenotypes. Wearable devices with implantable sensors and AI models trained on electronic health records and population biobanks enable the prediction of hypertension development and disease progression and allow for real-time crisis detection and non-adherence monitoring. The combination of pharmacotherapy with personalized lifestyle prescriptions provides better treatment results. Nanotechnology through sustained-release and tissue-targeted delivery systems and gene-based treatments using CRISPR and RNA modalities show promise to achieve disease-modifying control for patient groups. The combination of omics research with biomarkers and AI and digital health technologies enables hypertension care to shift from reactive and empirical methods to predictive and preventive and personalized approaches but requires evidence-based implementation at scale for all patients.