Hypertension affects more than 50 million people in the United States and is the most common disease forwhich adults seek medical attention. Studies of hypertension awareness, treatment, and control acrossethnic groups indicate that significant disparities exist within the African-American and Hispanic communitiescompared to non-Hispanic Whites. Specifically, greater efforts are needed specifically to prevent and treathigh blood pressure among African-Americans. While the prevalence of hypertension is lower in Hispaniccommunities, they have higher treated blood pressure than comparable White populations. To betterunderstand the factors that effect control of blood pressure in hypertensives on antihypertensive therapies,we are taking advantage of a large cohort of hypertensives and their sibs with extensive clinical, social,behavioral, and genetic data from the Genetic Epidemiology Network of Arteriopathy (GENOA) study.It is well known that hypertensives respond heterogeneously to anti-hypertensive therapies, often requiringmultiple medications to lower their blood pressure. This heterogeneity reflects a wide variety of factors thatinfluence interindividual variation in the pharmacokinetic (i.e. mechanisms of drug absorption, distribution,metabolism, or excretion) or pharmacodynamic (i.e. biochemical and physiological mechanisms associatedwith the drug target) properties of a drug. Other factors including demographic, familial influences,socioeconomic factors and lifestyle factors are also expected to influence blood pressure treatment andcontrol in hypertensives. Although this heterogeneity has long been established, relatively little is knownabout the specific social, behavioral, and genetic associations that influence ethnic variation in bloodpressure response to anti-hypertensive drugs. We propose to comprehensively investigate the sources ofvariation in blood pressure levels in hypertensives from the general clinical population that reflect the widespectrum of possible causes ranging from socio-demographic and lifestyle influences (Aim 1), theirassociation with the distribution of hypertension duration and treatment regimes (Aim 2), the impact of riskfactor-by-gene, gene-by-drug, or drug-by-risk factor interactions (Aim 3) in order to predict 5-year changes inblood pressure (Aim 4).
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