On pharmacogenetic approaches to hypertension treatment in pregnant women

Shikh E.V., Zhukova O.V., Ostroumova O.D., Sharonova S.S.

1) Department of Clinical Pharmacology and Propedeutics of Internal Diseases, Faculty of General Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia; 2) Department of Intermediate Level Therapy and Occupational Diseases, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
Hypertension in pregnancy is an urgent problem of modern medicine due to its high prevalence (it occurs in 5–30% of pregnant women in the Russian Federation) and to the risk of maternal and fetal complications. Considering the complex and incompletely studied pathogenesis of hypertension during pregnancy, the selection of antihypertensive therapy (AHT) remains open and is now being actively studied. In recent years, prescription of AHT for pregnant women has come under consideration in the context of personalized medicine. The genetic characteristics of a patient, which affect a pharmacological response, are point mutations and the so-called single nucleotide polymorphisms. The existence of single nucleotide polymorphisms in one gene or another can define the genetically determined contribution to an individual’s pharmacological response. Endothelial dysfunction that is manifested inter alia by decreased nitric oxide (NO) synthesis is an important pathogenetic element in the development of hypertension in pregnant women. There is a relationship between endothelial NO synthase (eNOS) (NOS3) gene polymorphism and AHT responses in preeclampsia (PE). The ‘C-Glu-a’ and ‘T-Asp-a’ haplotypes were found to be associated with the presence and absence of the response, respectively. There was no association of vascular endothelial growth factor gene polymorphismы (C-2578A rs699947) and (G-634C rs2010963) with AHT responses in PE. Taking into account the role of systemic inflammation in the development of hypertension in pregnant women, it seems important to study the level of proinflammatory cytokines, visfatin in particular, in these patients. The association between AHT responses and visfatin/NAMPT gene polymorphism is now being actively studied. The C, A haplotype was associated with AHT responses in patients with PE. Further investigation of genetic polymorphism and gene-drug interactions may contribute to the elaboration of new therapeutic approaches to prescribing AHT in pregnancy.

Keywords

hypertension
pregnancy
gestational hypertension
preeclampsia
antihypertensive therapy
pharmacogenetics

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Received 01.10.2019

Accepted 04.10.2019

About the Authors

Evgenia V. Shikh, MD, professor, head. Department of Clinical Pharmacology and Propaedeutics of Internal Medicine PMGMU them. THEM. Sechenov, Director of the Institute of Professional Education THEM. Sechenov. Tel.: +7 (495)915-58-01. E-mail: chih@mail.ru; ORCID 0000-0001-6589-7654 119991, Moscow, st. Trubetskaya, 8, bld. 2.
Olga V. Zhukova, candidate of medical sciences, assistant of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases I.M.Sechenova.
E-mail: dr_zhukova@mail.ru; ORCID 0000-0002-0994-2833 119991, Moscow, st. Trubetskaya, 8, bld. 2
Olga D. Ostroumova, MD, professor, professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases THEM. Sechenov, Professor, Department of Faculty Therapy and Occupational Diseases, Moscow State Medical and Dental University A.I. Evdokimova. E-mail: ostroumova.olga@mail.ru; ORCID0000-0002-0795-8225
119991, Moscow, st. Trubetskaya, 8, bld. 2. 127473, Moscow, st. Delegatskaya, d.20, bld. 1.
Svetlana S. Sharonova, student of PSMU named after I.M.Sechenova, Faculty of Medicine, 4 year, 11 group. Email: lana.sh917@gmail.com;
Tel .: +7(925)261-4403; ORCID0000-0002-9215-9339 119991, Moscow, st. Trubetskaya, 8, bld. 2.

For citation: Shikh E.V., Zhukova O.V., Ostroumova O.D., Sharonova S.S.
On pharmacogenetic approaches to hypertension treatment in pregnant women.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020;2: 22-28 (In Russian).
https://dx.doi.org/10.18565/aig.2020.2.22-28

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