Background There exists a wide interindividual variability in blood pressure ( BP ) response to β ₁ ‐blockers. To identify the genetic determinants of this variability, we performed a pharmacogenomic genome‐wide meta‐analysis of genetic variants influencing β ₁ ‐blocker BP response. Methods and Results Genome‐wide association analysis for systolic BP and diastolic BP response to β ₁ ‐blockers from 5 randomized clinical trials consisting of 1254 patients with hypertension of European ancestry were combined in meta‐analysis and single nucleotide polymorphisms (SNPs) with P <10 ⁻⁴ were tested for replication in 2 independent randomized clinical trials of β ₁ ‐blocker–treated patients of European ancestry (n=1552). Regions harboring the replicated SNP s were validated in a β ₁ ‐blocker–treated black cohort from 2 randomized clinical trials (n=315). A missense SNP rs28404156 in BST 1 was associated with systolic BP response to β ₁ ‐blockers in the discovery meta‐analysis ( P =9.33×10 ⁻⁵ , β=−3.21 mm Hg) and replicated at Bonferroni significance ( P =1.85×10 ⁻⁴ , β=−4.86 mm Hg) in the replication meta‐analysis with combined meta‐analysis approaching genome‐wide significance ( P =2.18×10 ⁻⁷ ). This SNP in BST 1 is in linkage disequilibrium with several SNP s with putative regulatory functions in nearby genes, including CD 38 , FBXL 5 , and FGFBP 1 , all of which have been implicated in BP regulation. SNP s in this genetic region were also associated with BP response in the black cohort. Conclusions Data from randomized clinical trials of 8 European ancestry and 2 black cohorts support the assumption that BST 1 containing locus on chromosome 4 is associated with β ₁ ‐blocker BP response. Given the previous associations of this region with BP , this is a strong candidate region for future functional studies and potential use in precision medicine approaches for BP management and risk prediction.