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The effect of CYP2C9 gene polymorphisms on blood pressure lowering response to losartan in patients with essential hypertension

Year 2022, Volume: 47 Issue: 3, 1015 - 1023, 30.09.2022
https://doi.org/10.17826/cumj.1093761

Abstract

Purpose: In this study, the possible effects of CYP2C9 polymorphisms on the clinical response to losartan were investigated in a group of hypertensive patients.
Materials and Methods: Seventy-four patients, newly diagnosed to have essential hypertension, and were subsequently prescribed losartan by attending physicians, were prospectively recruited for the study. Blood pressure measurements at the initiation of losartan treatment and six weeks after were completed for all participants. Genetic analysis for CYP2C9 polymorphisms was performed in blood samples collected at baseline. CYP2C9 *2 and *3 variant alleles were genotyped, and polymorphic patients' treatment responses were compared with the patients' who were carrying the wild type genotype.
Results: Analysis comparing the wild type genotype and CYP2C9*1*2 genotype revealed a trend toward more systolic blood pressure reduction in favor of wild-type genotype. However, there was no statistically significant difference between these two groups considering the change in diastolic blood pressure levels. Regarding the CYP2C9*1*3 genotype, there were no significant differences in systolic or diastolic blood pressure changes.
Conclusion: CYP2C9*1*2 polymorphism affects the systolic blood pressure response to losartan in hypertensive patients, while the CYP2C9*1*3 genotype was not shown in associated with systolic or diastolic blood pressure responses.
Keywords: Hypertension, losartan, CYP2C9, genetic polymorphism, pharmacogenetics

References

  • 1. Melville S, Byrd JB. Personalized Medicine and the Treatment of Hypertension. Curr Hypertens Rep. 2019 Feb 12;21(2):13. doi: 10.1007/s11906-019-0921-3.
  • 2. Göktaş MT, Pepedil F, Karaca Ö, Kalkışım S, Cevik L, Gumus E, et al. Relationship between genetic polymorphisms of drug efflux transporter MDR1 (ABCB1) and response to losartan in hypertension patients. Eur Rev Med Pharmacol Sci. 2016;20(11):2460-7.
  • 3. Goldstein JA. Clinical relevance of genetic polymorphisms in the human CYP2C subfamily. Br J Clin Pharmacol. 2001 Oct;52(4):349-55. doi: 10.1046/j.0306-5251.2001.01499.x.
  • 4. Ayyappadihas R, Dhanalekshmi U, Jestin H. CYP 2D6*4 polymorphism and interindividual response variation to metoprolol in stage 1 hypertensive patients: no association in a rural Indian population? Turk J Med Sci. 2015;45(2):352-7. doi: 10.3906/sag-1307-133.
  • 5. Tavares LC, Marcatto LR, Santos PCJL. Genotype-guided warfarin therapy: current status. Pharmacogenomics. 2018;19(7):667-685. doi: 10.2217/pgs-2017-0207.
  • 6. Manikandan P, Nagini S. Cytochrome P450 Structure, Function and Clinical Significance: A Review. Curr Drug Targets. 2018;19(1):38-54. doi: 10.2174/1389450118666170125144557.
  • 7. Zhou SF, Zhou ZW, Huang M. Polymorphisms of human cytochrome P450 2C9 and the functional relevance. Toxicology. 2010;278(2):165-88. doi: 10.1016/j.tox.2009.08.013.
  • 8. Wang B, Wang J, Huang SQ, Su HH, Zhou SF. Genetic polymorphism of the human cytochrome P450 2C9 gene and its clinical significance. Curr Drug Metab. 2009;10(7):781-834. doi: 10.2174/138920009789895480.
  • 9. Song JC, White CM. Pharmacologic, pharmacokinetic, and therapeutic differences among angiotensin II receptor antagonists. Pharmacotherapy. 2000;20(2):130-9. doi: 10.1592/phco.20.3.130.34788.
  • 10. Yasar U, Tybring G, Hidestrand M, Oscarson M, Ingelman-Sundberg M, Dahl ML, Eliasson E. Role of CYP2C9 polymorphism in losartan oxidation. Drug Metab Dispos. 2001;29(7):1051-6.
  • 11. https://www.pharmvar.org/gene/CYP2C9 (Accessed, Feb 2022)
  • 12. Daly AK. Optimal dosing of warfarin and other coumarin anticoagulants: the role of genetic polymorphisms. Arch Toxicol. 2013;87(3):407-20. doi: 10.1007/s00204-013-1013-9.
  • 13. Silvado CE, Terra VC, Twardowschy CA. CYP2C9 polymorphisms in epilepsy: influence on phenytoin treatment. Pharmgenomics Pers Med. 2018;11:51-58. doi: 10.2147/PGPM.S108113.
  • 14. Hallberg P, Karlsson J, Kurland L, Lind L, Kahan T, Malmqvist K, et al. The CYP2C9 genotype predicts the blood pressure response to irbesartan: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs Atenolol (SILVHIA) trial. J Hypertens. 2002;20(10):2089-93. doi: 10.1097/00004872-200210000-00030.
  • 15. Lajer M, Tarnow S, Andersen S, Parving HH. CYP2C9 variant modifies blood pressure-lowering response to losartan in Type 1 diabetic patients with nephropathy. Diabetic Medicine. 2007;(24): 322-328. doi:10.1111/j.1464-5491.2007.02086.x
  • 16. Yin T, Maekawa K, Kamide K, Saito Y, Hanada H, Miyashita K, et al. Genetic variations of CYP2C9 in 724 Japanese individuals and their impact on the antihypertensive effects of losartan. Hypertens Res. 2008;31(8):1549-57. doi: 10.1291/hypres.31.1549.
  • 17. Babaoglu MO, Yasar U, Sandberg M, Eliasson E, Dahl ML, Kayaalp SO, et al. CYP2C9 genetic variants and losartan oxidation in a Turkish population. Eur J Clin Pharmacol. 2004;60(5):337-42. doi: 10.1007/s00228-004-0785-5.
  • 18. Yasar U, Forslund-Bergengren C, Tybring G, Dorado P, Llerena A, Sjöqvist F, et al. Pharmacokinetics of losartan and its metabolite E-3174 in relation to the CYP2C9 genotype. Clin Pharmacol Ther. 2002;71(1):89-98. doi: 10.1067/mcp.2002.121216.
  • 19. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28(12):1462-536. doi: 10.1093/eurheartj/ehm236.
  • 20. Joy MS, Dornbrook-Lavender K, Blaisdell J, Hilliard T, Boyette T, Hu Y, et al. CYP2C9 genotype and pharmacodynamic responses to losartan in patients with primary and secondary kidney diseases. Eur J Clin Pharmacol. 2009;65(9):947-53. doi: 10.1007/s00228-009-0707-7.
  • 21. Lee CR, Goldstein JA, Pieper JA. Cytochrome P450 2C9 polymorphisms: a comprehensive review of the in-vitro and human data. Pharmacogenetics. 2002;12(3):251-63. doi: 10.1097/00008571-200204000-00010.
  • 22. Schwarz UI. Clinical relevance of genetic polymorphisms in the human CYP2C9 gene. Eur J Clin Invest. 2003;33 Suppl 2:23-30. doi: 10.1046/j.1365-2362.33.s2.6.x.
  • 23. Aynacioglu AS, Brockmöller J, Bauer S, Sachse C, Güzelbey P, Ongen Z, et al. Frequency of cytochrome P450 CYP2C9 variants in a Turkish population and functional relevance for phenytoin. Br J Clin Pharmacol. 1999;48(3):409-15. doi: 10.1046/j.1365-2125.1999.00012.x.
  • 24. Kamali F, Wynne H. Pharmacogenetics of warfarin. Annu Rev Med. 2010;61:63-75. doi: 10.1146/annurev.med.070808.170037.

CYP2C9 gen polimorfizmlerinin losartan kullanan hipertansif hastalarda tedavi yanıtı üzerine etkisi

Year 2022, Volume: 47 Issue: 3, 1015 - 1023, 30.09.2022
https://doi.org/10.17826/cumj.1093761

Abstract

Amaç: Bu çalışmada, anti-hipertansif olarak losartan kullanan hastalarda CYP2C9 polimorfizmlerinin tedavi yanıtı üzerine etkileri incelenmiştir.
Yöntemler: Araştırmaya yeni tanı almış, evre 1 esansiyel hipertansiyonu olan 74 hasta dahil edildi. Bu hastalara tedavi öncesi ve losartan başlandıktan altı hafta sonra kan basıncı ölçümleri yapılarak elde edilen kan basıncı düşüşleri kaydedildi. Hastalardan ilk tanı sırasında alınmış olan kan örneklerinden DNA izolasyonu yapılarak CYP2C9 *2 ve *3 polimorfik alelleri için genetik analizler yapıldı. Polimorfik alelleri taşıyan bireyler ile yabanıl tip (wild-type) genotip taşıyıcılarının anti-hipertansif tedavi yanıtları karşılaştırıldı.
Bulgular: CYP2C9*1*2 genotipine sahip hastalar, yabanıl tip genotipe sahip hastalar ile kıyaslandığında diyastolik kan basıncı için gruplar arasında istatistiksel açıdan anlamlı fark saptanmazken, sistolik kan basıncındaki düşüşün yabanıl tip genotipe sahip hastalarda daha belirgin olma eğiliminde olduğu görüldü. CYP2C9*1*3 genotipi ise tedavi sonuçlarında anlamlı bir değişikliğe neden olmadı.
Sonuç: Bulgularımız, CYP2C9*1*2 polimorfizminin hipertansif hastaların losartan ile tedavisinde sistolik kan basıncı yanıtını etkileyebileceğini düşündürmektedir. Öte yandan, CYP2C9*1*3 genotipinin sistolik veya diyastolik kan basıncı yanıtlarıyla ilişkisi gösterilememiştir.
Anahtar kelimeler: Hipertansiyon, losartan, CYP2C9, genetik polimorfizm, farmakogenetik

References

  • 1. Melville S, Byrd JB. Personalized Medicine and the Treatment of Hypertension. Curr Hypertens Rep. 2019 Feb 12;21(2):13. doi: 10.1007/s11906-019-0921-3.
  • 2. Göktaş MT, Pepedil F, Karaca Ö, Kalkışım S, Cevik L, Gumus E, et al. Relationship between genetic polymorphisms of drug efflux transporter MDR1 (ABCB1) and response to losartan in hypertension patients. Eur Rev Med Pharmacol Sci. 2016;20(11):2460-7.
  • 3. Goldstein JA. Clinical relevance of genetic polymorphisms in the human CYP2C subfamily. Br J Clin Pharmacol. 2001 Oct;52(4):349-55. doi: 10.1046/j.0306-5251.2001.01499.x.
  • 4. Ayyappadihas R, Dhanalekshmi U, Jestin H. CYP 2D6*4 polymorphism and interindividual response variation to metoprolol in stage 1 hypertensive patients: no association in a rural Indian population? Turk J Med Sci. 2015;45(2):352-7. doi: 10.3906/sag-1307-133.
  • 5. Tavares LC, Marcatto LR, Santos PCJL. Genotype-guided warfarin therapy: current status. Pharmacogenomics. 2018;19(7):667-685. doi: 10.2217/pgs-2017-0207.
  • 6. Manikandan P, Nagini S. Cytochrome P450 Structure, Function and Clinical Significance: A Review. Curr Drug Targets. 2018;19(1):38-54. doi: 10.2174/1389450118666170125144557.
  • 7. Zhou SF, Zhou ZW, Huang M. Polymorphisms of human cytochrome P450 2C9 and the functional relevance. Toxicology. 2010;278(2):165-88. doi: 10.1016/j.tox.2009.08.013.
  • 8. Wang B, Wang J, Huang SQ, Su HH, Zhou SF. Genetic polymorphism of the human cytochrome P450 2C9 gene and its clinical significance. Curr Drug Metab. 2009;10(7):781-834. doi: 10.2174/138920009789895480.
  • 9. Song JC, White CM. Pharmacologic, pharmacokinetic, and therapeutic differences among angiotensin II receptor antagonists. Pharmacotherapy. 2000;20(2):130-9. doi: 10.1592/phco.20.3.130.34788.
  • 10. Yasar U, Tybring G, Hidestrand M, Oscarson M, Ingelman-Sundberg M, Dahl ML, Eliasson E. Role of CYP2C9 polymorphism in losartan oxidation. Drug Metab Dispos. 2001;29(7):1051-6.
  • 11. https://www.pharmvar.org/gene/CYP2C9 (Accessed, Feb 2022)
  • 12. Daly AK. Optimal dosing of warfarin and other coumarin anticoagulants: the role of genetic polymorphisms. Arch Toxicol. 2013;87(3):407-20. doi: 10.1007/s00204-013-1013-9.
  • 13. Silvado CE, Terra VC, Twardowschy CA. CYP2C9 polymorphisms in epilepsy: influence on phenytoin treatment. Pharmgenomics Pers Med. 2018;11:51-58. doi: 10.2147/PGPM.S108113.
  • 14. Hallberg P, Karlsson J, Kurland L, Lind L, Kahan T, Malmqvist K, et al. The CYP2C9 genotype predicts the blood pressure response to irbesartan: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation vs Atenolol (SILVHIA) trial. J Hypertens. 2002;20(10):2089-93. doi: 10.1097/00004872-200210000-00030.
  • 15. Lajer M, Tarnow S, Andersen S, Parving HH. CYP2C9 variant modifies blood pressure-lowering response to losartan in Type 1 diabetic patients with nephropathy. Diabetic Medicine. 2007;(24): 322-328. doi:10.1111/j.1464-5491.2007.02086.x
  • 16. Yin T, Maekawa K, Kamide K, Saito Y, Hanada H, Miyashita K, et al. Genetic variations of CYP2C9 in 724 Japanese individuals and their impact on the antihypertensive effects of losartan. Hypertens Res. 2008;31(8):1549-57. doi: 10.1291/hypres.31.1549.
  • 17. Babaoglu MO, Yasar U, Sandberg M, Eliasson E, Dahl ML, Kayaalp SO, et al. CYP2C9 genetic variants and losartan oxidation in a Turkish population. Eur J Clin Pharmacol. 2004;60(5):337-42. doi: 10.1007/s00228-004-0785-5.
  • 18. Yasar U, Forslund-Bergengren C, Tybring G, Dorado P, Llerena A, Sjöqvist F, et al. Pharmacokinetics of losartan and its metabolite E-3174 in relation to the CYP2C9 genotype. Clin Pharmacol Ther. 2002;71(1):89-98. doi: 10.1067/mcp.2002.121216.
  • 19. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28(12):1462-536. doi: 10.1093/eurheartj/ehm236.
  • 20. Joy MS, Dornbrook-Lavender K, Blaisdell J, Hilliard T, Boyette T, Hu Y, et al. CYP2C9 genotype and pharmacodynamic responses to losartan in patients with primary and secondary kidney diseases. Eur J Clin Pharmacol. 2009;65(9):947-53. doi: 10.1007/s00228-009-0707-7.
  • 21. Lee CR, Goldstein JA, Pieper JA. Cytochrome P450 2C9 polymorphisms: a comprehensive review of the in-vitro and human data. Pharmacogenetics. 2002;12(3):251-63. doi: 10.1097/00008571-200204000-00010.
  • 22. Schwarz UI. Clinical relevance of genetic polymorphisms in the human CYP2C9 gene. Eur J Clin Invest. 2003;33 Suppl 2:23-30. doi: 10.1046/j.1365-2362.33.s2.6.x.
  • 23. Aynacioglu AS, Brockmöller J, Bauer S, Sachse C, Güzelbey P, Ongen Z, et al. Frequency of cytochrome P450 CYP2C9 variants in a Turkish population and functional relevance for phenytoin. Br J Clin Pharmacol. 1999;48(3):409-15. doi: 10.1046/j.1365-2125.1999.00012.x.
  • 24. Kamali F, Wynne H. Pharmacogenetics of warfarin. Annu Rev Med. 2010;61:63-75. doi: 10.1146/annurev.med.070808.170037.
There are 24 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Funda Pepedil Tanrikulu 0000-0003-1878-1872

Melih O. Babaoglu 0000-0001-9351-1261

Banu Çakır 0000-0001-6645-6527

Atilla Bozkurt 0000-0001-6102-8865

Gülay Sain Güven 0000-0001-8176-9767

Publication Date September 30, 2022
Acceptance Date July 17, 2022
Published in Issue Year 2022 Volume: 47 Issue: 3

Cite

MLA Pepedil Tanrikulu, Funda et al. “The Effect of CYP2C9 Gene Polymorphisms on Blood Pressure Lowering Response to Losartan in Patients With Essential Hypertension”. Cukurova Medical Journal, vol. 47, no. 3, 2022, pp. 1015-23, doi:10.17826/cumj.1093761.