Prevalence of hypertension (HTN) varies substantially across different populations. HTN is not only common – affecting at least one third of the world’s adult population – but is also the most important driver for cardiovascular diseases. Yet up to a third of hypertensive patients are resistant to therapy, contributed by secondary hypertension but more commonly the hitherto inability to precisely predict response to specific antihypertensive agents. Population and individual genomics information could be useful in guiding the selection and predicting the response to treatment – an approach known as precision medicine. However this cannot be achieved without the knowledge of genetic variations that influence blood pressure (BP). A number of evolutionary factors including population demographics and forces of natural selection may be involved. This article explores some ideas on how natural selection influences BP regulation in ethnically and geographically diverse populations that could lead to them being susceptible to HTN. We explore how such evolutionary factors could impact the implementation of precision medicine in HTN. Finally, in order to ensure the success of precision medicine in HTN, we call for more initiatives to understand the genetic architecture within and between diverse populations with ancestry from different parts of the world, and to precisely classify the intermediate phenotypes of HTN.

中文翻译：

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血压调节的自然选择和局部适应及其对高血压精准医学的展望

不同人群的高血压 (HTN) 患病率差异很大。HTN 不仅很常见——至少影响到世界上三分之一的成年人口——而且还是心血管疾病最重要的驱动因素。然而，多达三分之一的高血压患者对治疗有抵抗力，这是由继发性高血压引起的，但更常见的是迄今为止无法准确预测对特定抗高血压药物的反应。人口和个体基因组学信息可用于指导选择和预测治疗反应——这种方法被称为精准医学。然而，如果不了解影响血压 (BP) 的遗传变异，就无法实现这一目标。可能涉及许多进化因素，包括人口统计和自然选择的力量。本文探讨了自然选择如何影响种族和地理多样化人群的血压调节，从而导致他们对高血压易感的一些想法。我们探讨了这些进化因素如何影响 HTN 中精准医疗的实施。最后，为了确保 HTN 精准医疗的成功，我们呼吁采取更多举措来了解具有世界不同地区血统的不同人群内部和之间的遗传结构，并对 HTN 的中间表型进行精确分类。