Hypertension is an important lifestyle-related disease that occurs worldwide. Epidemiological studies have shown that hypertension contributes significantly to mortality in the Japanese population [1]. The 2019 Japanese Society of Hypertension Guidelines stated that lifestyle modification is the cornerstone of antihypertensive therapy, recommending that it be prioritized before initiating treatment and maintained alongside antihypertensive therapy [2]. Studies have shown that approximately 50% of cardiovascular events are linked to modifiable risk factors [3, 4], making lifestyle changes a fundamental aspect of managing lifestyle-related conditions. However, implementing and sustaining lifestyle modification can be very challenging, as it requires various efforts such as reducing salt intake, weight loss, exercise, smoking cessation, and moderating alcohol consumption. Since lifestyle-related diseases often arise from the difficulty of self-regulating diet and behavior, it is understandable that these changes are hard to maintain. However, some individuals do not exhibit an elevation in blood pressure even when engaging in unhealthy habits, such as excessive salt intake and lack of exercise, a phenomenon that is often observed in general clinical practice.

Takase et al. quantitatively estimated the relationship between combined genetic and lifestyle risks and the prevalence of hypertension and home hypertension [5]. Their findings revealed that for individuals with low genetic risk, a poor lifestyle was a risk factor for hypertension and home hypertension. However, participants with a high genetic risk needed to closely monitor their blood pressure, even if they maintain a healthy lifestyle. This indicates that the impact of lifestyle modifications on blood pressure differs depending on genetic factors. While individuals with a low genetic risk can achieve significant blood pressure reduction through lifestyle modifications, those with a high genetic risk may experience limited reductions in blood pressure through lifestyle modifications and must remain vigilant about the risk of blood pressure elevation. However, this does not suggest that individuals with a high genetic risk do not need to modify their lifestyle, as their blood pressure will not decrease even if they modify their lifestyle. As the study concludes, “lifestyle is important to prevent hypertension; nevertheless, participants with high genetic risk should carefully monitor their blood pressure despite a healthy lifestyle.”

This study offers a novel finding by showing that genetic predisposition affects the extent of blood pressure reduction through lifestyle modification. It marks a significant step toward developing tailored lifestyle modification strategies. Research on genetic predispositions and social implementation in the field of cancer has witnessed notable progress. In the field of breast cancer, one of the most advanced cancers, the BRCA1/2 gene plays a crucial role, and the value of multi-gene panel tests for assessing genetic risk is being evaluated in other cancers as well [6]. These gene panels are used to evaluate sensitivity to anticancer drugs and help tailor chemotherapy regimens, making a significant contribution to improving the prognosis of malignant neoplasms and reducing side effects. With further clarification of the relationship between lifestyle and genetic factors and blood pressure, lifestyle-sensitive genes could be identified. For instance, individuals with salt-sensitive genes can be advised to reduce their salt intake, while those with exercise-responsive genes can receive specific exercise guidance (Figure). This approach could lead to more efficient and sustainable blood pressure control through individualized lifestyle modifications. To achieve this efficient future, detailed genetic analyses and cohort studies with comprehensive lifestyle data are necessary. I hope to see the implementation of lifestyle modification guidance using genetic panels in the future, with collaboration in Japan and across other Asian countries.