Association of a CCB-Related Pharmacogenomics-Guided Strategy with Blood Pressure Outcomes and Short-Term Safety in Chinese Patients with Hypertension: A Secondary Exploratory Analysis of Two Randomized Cohorts

Introduction: rs776746 with short-term blood pressure (BP) outcomes among Chinese patients with hypertension receiving CCB-containing regimens. Methods: This secondary exploratory analysis included patients receiving CCB-containing regimens from two previously completed multicenter randomized cohorts conducted in Hunan and Fujian provinces, China. The Hunan cohort assessed a 4-week PGx-guided strategy combined with structured management, while the Fujian cohort evaluated genotype-guided treatment during 4-8 weeks after an initial standardized management phase. The primary endpoint was BP control at the last follow-up; secondary endpoints included changes in systolic BP (SBP) and diastolic BP (DBP), medication use, and short-term safety outcomes. Multivariable regression models were used to adjust for prespecified clinical covariates. Results: A total of 4608 patients in Hunan and 418 patients in Fujian were included. In the Hunan cohort, the genotype-guided group had higher 4‑week BP control (81.83% vs 25.07%; adjusted OR = 14.56, P < 0.001) and greater SBP/DBP decreases. In the Fujian cohort, genotype-guided therapy was associated with higher 8‑week BP control (81.74% vs 77.39%; adjusted OR = 2.43, P = 0.003) and greater DBP decrease. Associations were stronger among patients whose BP remained uncontrolled after standardized management. No short-term safety concerns were identified. Conclusion: rs776746, was associated with improved short-term BP control among Chinese patients with hypertension receiving CCB-containing regimens, without an apparent short-term safety disadvantage. However, these findings should be interpreted as exploratory associations rather than proof of causal benefit. Further prospective randomized studies are needed to confirm these findings.