Impact of Genetic Polymorphism on Antihypertensive Drug Response: Comparing ACE Inhibitors and ARBs – A Systematic Review and Meta-Analysis

Presenter: Deekshith Ameer Shaik

Genetic polymorphisms significantly affect individual responses to antihypertensive drugs, especially ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). 

This systematic review and meta-analysis found that ACEI efficacy is notably affected by the I/D polymorphism in the ACE gene, while ARB response is modulated by M235T variants in the AGT gene and -344T/C in CYP11B2. Variants in ADRB2 (e.g., rs1042713) also contribute to differential outcomes. ARBs showed more consistent blood pressure reductions across genotypes, whereas ACEIs exhibited greater variability. These findings support the use of pharmacogenomic-guided therapy to personalize hypertension management, resulting in improved clinical outcomes and greater precision in treatment for genetically diverse adult populations.

Comparable One-Year Efficacy and Safety of Spironolactone Versus Amiloride in Resistant Hypertension: A Retrospective Cohort Analysis

Presenter: Mohamed S. Elgendy

This retrospective cohort study utilized data from TriNetX database to compare the clinical outcomes of treatment with amiloride and spironolactone in patients with resistant hypertension (n=414 in each group) over a period of 52 weeks.

At 4 weeks, greater proportion of patients treated with amiloride had better BP control (SBP ≤130 mm Hg: 53.6% vs. 44.2%, RR: 1.21; DBP ≤80 mm Hg: 62.3% vs. 53.6%, RR: 1.16). However, by 52 weeks, there was no group-difference BP control (SBP ≤ 130, SBP ≤ 140, DBP ≤ 80, DBP ≤ 90), acute kidney injury (AKI; 13.0% vs. 15.2%, RR: 0.86), all-cause mortality (13.3% vs. 11.1%, RR 1.20), and MACE (MACE defined as all-cause mortality, myocardial infarction, and ischemic or hemorrhagic stroke) (22.5% vs. 23.7%, RR: 0.95). Both, amiloride and spironolactone exhibited similar one-year outcomes for incident AKI, MACE, all-cause mortality, and BP control. 

AHA 2025, November 7^th-10^th 2025, New Orleans, Louisiana, USA