Receipt of genetic risk information significantly improvesbloodpressure controlamongafricanan-cestry adults with hypertension: Results of a randomized trial

Background: People with African ancestry (AAs) have increased risk of kidney failure compared to European Americans (EAs) due to numerous factors. Two variants in the APOL1 gene (APOL1 +) account for much of this AA-EA disparity. APOL1+ patients with hypertension have 10x increased risk of kidney failure. We conducted an RCT to evaluate the effects and challenges of incorporating this genetic risk information into primary care. Methods: Our community-clinical-academic team recruited AA adult patients with hypertension from 15 diverse primary care sites in NYC and randomized them to APOL1 genetic testing at baseline (intervention) or at one year (waitlist control). Trained staff returned APOL1 results to patients with low-literacy educational materials. Real-time clinical decision support tools alerted clinicians of their patients' APOL1 results and associated risk at point of care. Our primary outcome was systolic BP (SBP) at 3 months comparing intervention patients who are APOL1+ vs. APOL1-. Results: The 2052 AA adults had a mean age of 52y, 67% were female, 57% had income < 30k/year, 44% had < college education. At baseline, APOL1+ patients had mean SBP of 137mmHg vs 134mmHg in APOL1-(p= 0.02). At 3m (retention rate 93%), this SBP disparity was eliminated: both groups had mean SBP of 131mmHg (p=0.08). The % with controlled SBP (< 140mmHg) at 3m increased among APOL1+'s from 60% to 74% vs 67% to 73 % in APOL1-'s (GEE time-intervention type interaction p=0.03). There were no differences from baseline to 3m, or between + and-patients in self-rated heath, trust in provider, perceived racism or anxiety; but significanly more +'s at 3m said they made changes to how they took their medicines (p< 0.001); 95% of patients would get tested again. Conclusions: AA patients with hypertension informed they have a genetic increased risk of kidney failure have a greater reduction in SBP and improvement in % with controlled SBP at 3m, as compared with those told they do not have an increased risk, are satisfied with the process of testing and return of results, report positive behavior change, but not increased negative affect. This indicates, at least in the short term, that chronic disease genetic risk information can be of benifit to AA individuals. Systolic Blood Pressure Change at 3-Month by Genotype among Intervention Patients [Figure Presented].