Gene Variant Flags Blood Pressure Drug Liver Risk

A genetic marker found in half of antihypertensive-related liver injury cases may help identify patients at higher risk.

Updated on Nov. 4, 2026 in Heart Disease

Gene Variant Flags Blood Pressure Drug Liver Risk

Researchers identified the HLA-B*35:01 genetic variant in half of 44 liver injury cases linked to antihypertensive drugs in the U.S. Drug-Induced Liver Injury Network. Carriers developed injury sooner after starting treatment than non-carriers.

Why it matters

Antihypertensive drugs are widely prescribed to patients with heart disease, so a marker that flags those at greater risk of liver injury could inform prescribing decisions. The findings point toward an accelerated adaptive immune response as a possible mechanism.

Of 2,207 high-confidence U.S. Drug-Induced Liver Injury Network cases from 2003 to 2024, HLA-B*35:01 appeared in 50% of the 44 antihypertensive-related cases versus 11% of other-agent cases (odds ratio 6.0, 95% CI 3.4-10.6). Whether the marker can reliably guide clinical screening has not been established.

The players

U.S. Drug-Induced Liver Injury Network

A national registry that collects and analyzes high-confidence cases of drug-induced liver injury across the United States.

The details

Most of the 44 antihypertensive-related cases involved ACE inhibitors or ARBs (14), methyldopa (13) and hydralazine (11), with methyldopa injury occurring in young women and consistently involving liver-cell damage. Two patients required liver transplantation, and carriers' injury onset came at 50 days after starting treatment versus 109 days for non-carriers.

Registry cases were collected between 2003 and 2024.
The antihypertensive liver injury study was published in 2026.

Landscape

The findings build on decades of registry-based surveillance of drug-induced liver injury in the United States, adding a genetic dimension to a field that has largely relied on clinical and case-level observation. They suggest that inherited immune factors, not just drug choice, may shape who is harmed by common blood pressure treatments.

Patients taking antihypertensive medications should continue prescribed treatment and discuss any new symptoms of liver injury with their clinician. The research does not yet support routine genetic testing before prescribing these drugs.

The takeaway

Genetic factors may help explain why some patients develop liver injury from blood pressure medications while others do not. Clinicians and researchers will need further study before this marker can inform everyday prescribing.