Gene-Targeted Hypertension Therapy. Is It Time for Indonesia?

Hypertension remains a significant global health challenge due to its high preva-lence and complications worldwide. The complex interactions between genetic, environmen-tal, and lifestyle factors mean that current pharmacological treatments for hypertension have limited long-term effectiveness, which can be characterized as refractory hypertension. Tar-geted gene therapy offers a revolutionary approach by addressing the underlying genetic mech-anisms of hypertension, providing a personalized, potentially curative solution with fewer side effects. In Indonesia, the implementation of targeted gene therapy for hypertension faces sig-nificant challenges due to limited genomic infrastructure, high costs of genetic testing, and low awareness among healthcare professionals and the public. This genetic approach is still limited to research or rare monogenic cases and has not been implemented routinely in clinical prac-tice. Ethical, cultural, and religious considerations also continue to limit public acceptance of this genetic intervention, in addition to the lack of a clear legal and regulatory framework gov-erning gene therapy and the protection of genetic data. Nevertheless, the Indonesian govern-ment, through the Biomedical Genome-based Science Initiative (BGSi), has begun to initiate medical integration, which aims to develop population-specific genomic databases, improve precision medicine, and build national capacity for future implementation of gene-based ther-apies, including for hypertension. This literature review aims to comprehensively examine hy-pertension and gene therapy, synthesizing global evidence on genetic mechanisms, therapeutic advances, and implementation challenges, while outlining future opportunities and strategies for integrating gene-based medicine into the Indonesian health care system.