Managing Refractory Hypertension: A Case Study Exploring the Influence of ACE and ACTN3 Gene Polymorphisms

The responses to Antihypertensive drugs vary among patients. The renal and muscular processes of blood flow regulation in peripheral blood vessels depend on the genetic and physiological constitution. Here, we present a case of an elderly female patient who experienced several phases of hypertensive emergencies during supervised training sessions. Hypertension treatment with different ACE inhibitors was discontinued because of severe side effects or simply no effect. Genotyping of ACE and ACTN3 gene polymorphisms helped find adequate antihypertensive treatment after all other approaches failed. The measured ACTN3-RR genotype indicated the possibility of a higher proportion of fast-twitch muscle fibers. This type of muscle fiber contributes to the generation of a high muscle force, which can compress the vascular bed more during physical work than slow muscle fibers. Therefore, a beta-blocker was used for treatment, allowing better vasodilative capacity. As reported by the patient, this pharmaceutical alone helped treat hypertensive emergencies adequately. Therefore, we believe that genetic information can help to identify optimal pharmaceutical treatments a problem that is highly prevalent in elderly subjects.