Abstract
It has long been known that genetic factors play a major role in determining an individual’s propensity to hypertension. In recent years, there has been major progress towards realizing the goal of identifying the specific genetic factors that lead to alterations in blood pressure. Of particular note, new genes regulating renal sodium handling and aldosterone regulation have been discovered via the study of rare Mendelian disorders. Similarly, a number of large genome-wide association studies have been completed, which have added to our understanding as well. Here, recent progress in the genetics of hypertension will be reviewed, with an emphasis towards highlighting specific areas where clinical practice has already or will soon be affected.
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Roger VL et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–220.
Banegas JR et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J. 2011;32(17):2143–52.
Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303(20):2043–50.
Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA. 1970;213(7):1143–52.
Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA. 1967;202(11): 1028–34.
Rice T et al. Cardiovascular risk factors in a French Canadian population: resolution of genetic and familial environmental effects on blood pressure using twins, adoptees, and extensive information on environmental correlates. Genet Epidemiol. 1989;6(5):571–88.
Feinleib M et al. The NHLBI twin study of cardiovascular disease risk factors: methodology and summary of results. Am J Epidemiol. 1977;106(4):284–5.
Biron P, Mongeau JG, Bertrand D. Familial aggregation of blood pressure in 558 adopted children. Can Med Assoc J. 1976;115(8):773–4.
Longini Jr IM et al. Environmental and genetic sources of familial aggregation of blood pressure in Tecumseh, Michigan. Am J Epidemiol. 1984;120(1):131–44.
Lifton RP, Gharavi AG, Geller DS. Molecular mechanisms of human hypertension. Cell. 2001;104(4):545–56.
Shimkets RA et al. Liddle’s syndrome: heritable human hypertension caused by mutations in the beta subunit of the epithelial sodium channel. Cell. 1994;79(3):407–14.
Hansson JH et al. Hypertension caused by a truncated epithelial sodium channel gamma subunit: genetic heterogeneity of Liddle syndrome. Nat Genet. 1995;11(1):76–82.
Warnock DG. Liddle syndrome: genetics and mechanisms of Na+ channel defects. Am J Med Sci. 2001;322(6):302–7.
Gordon RD et al. Evidence that primary aldosteronism may not be uncommon: 12 % incidence among antihypertensive drug trial volunteers. Clin Exp Pharmacol Physiol. 1993;20(5):296–8.
Mulatero P et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89(3):1045–50.
Loh KC et al. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab. 2000;85(8):2854–9.
Eide IK et al. Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens. 2004;22(11):2217–26.
Strauch B et al. Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region. J Hum Hypertens. 2003;17(5):349–52.
Mosso L et al. Primary aldosteronism and hypertensive disease. Hypertension. 2003;42(2):161–5.
Stowasser M et al. High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non-selective’ screening of hypertensive patients. J Hypertens. 2003;21(11):2149–57.
Gordon RD et al. High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol. 1994;21(4):315–8.
Gallay BJ et al. Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio. Am J Kidney Dis. 2001;37(4):699–705.
Calhoun DA et al. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension. 2002;40(6):892–6.
Stowasser M. Aldosterone excess and resistant hypertension: investigation and treatment. Curr Hypertens Rep. 2014;16(7):439.
Lifton RP et al. Hereditary hypertension caused by chimaeric gene duplications and ectopic expression of aldosterone synthase. Nat Genet. 1992;2(1):66–74.
Choi M et al. K+ channel mutations in adrenal aldosterone-producing adenomas and hereditary hypertension. Science. 2011;331(6018):768–72. This study opened the door to our improved understanding of genetic mechanisms underlying primary aldosteronism.
Geller DS et al. A novel form of human Mendelian hypertension featuring nonglucocorticoid-remediable aldosteronism. J Clin Endocrinol Metab. 2008;93(8):3117–23.
Boulkroun S et al. Prevalence, clinical, and molecular correlates of KCNJ5 mutations in primary aldosteronism. Hypertension. 2012;59(3):592–8.
Azizan EA et al. Somatic mutations in ATP1A1 and CACNA1D underlie a common subtype of adrenal hypertension. Nat Genet. 2013;45(9):1055–60.
Beuschlein F et al. Somatic mutations in ATP1A1 and ATP2B3 lead to aldosterone-producing adenomas and secondary hypertension. Nat Genet. 2013;45(4):440–4. 444e1-2.
Scholl UI et al. Somatic and germline CACNA1D calcium channel mutations in aldosterone-producing adenomas and primary aldosteronism. Nat Genet. 2013;45(9):1050–4.
Scholl UI et al. Recurrent gain of function mutation in calcium channel CACNA1H causes early-onset hypertension with primary aldosteronism. Elife. 2015;4:e06315.
Scholl UI et al. Hypertension with or without adrenal hyperplasia due to different inherited mutations in the potassium channel KCNJ5. Proc Natl Acad Sci U S A. 2012;109(7):2533–8.
Wilson FH et al. Human hypertension caused by mutations in WNK kinases. Science. 2001;293(5532):1107–12.
Hoorn EJ et al. The calcineurin inhibitor tacrolimus activates the renal sodium chloride cotransporter to cause hypertension. Nat Med. 2011;17(10):1304–9.
Boyden LM et al. Mutations in kelch-like 3 and cullin 3 cause hypertension and electrolyte abnormalities. Nature. 2012;482(7383):98–102. This paper used an exome-wide screening to identify causative mutations which underlie the phenotype of hypertension with hyperkalemia. These mutations will likely greatly aid our understanding of thiazide sensitive cotransporter physiology.
Huang CL, Cheng CJ. A unifying mechanism for WNK kinase regulation of sodium-chloride cotransporter. Pflugers Arch. 2015.
Schuster H et al. Autosomal dominant hypertension and brachydactyly in a Turkish kindred resembles essential hypertension. Hypertension. 1996;28(6):1085–92.
Schuster H et al. Severe autosomal dominant hypertension and brachydactyly in a unique Turkish kindred maps to human chromosome 12. Nat Genet. 1996;13(1):98–100.
Maass PG, et al., PDE3A mutations cause autosomal dominant hypertension with brachydactyly. Nat Genet, 2015. 47(6): 647–53. Maass et al. identified mutations causing hypertension with brachydactyly, a phenotype that had eluded characterization for many years. The demonstration that mutations in PDE3A cause this phenotype suggests a novel pathway leading to hypertension, and may lead to an improved understanding of vascular injury in hypertension
Ge D et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009;461(7262):399–401.
Newton-Cheh C et al. Genome-wide association study identifies eight loci associated with blood pressure. Nat Genet. 2009;41(6):666–76.
Levy D et al. Genome-wide association study of blood pressure and hypertension. Nat Genet. 2009;41(6):677–87.
International Consortium for Blood Pressure Genome-Wide Association, Studies et al. Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk. Nature. 2011;478(7367):103–9.
Munroe PB, Barnes MR, Caulfield MJ. Advances in blood pressure genomics. Circ Res. 2013;112(10):1365–79.
Kurtz TW. Genome-wide association studies will unlock the genetic basis of hypertension: con side of the argument. Hypertension. 2010;56(6):1021–5.
Turner ST et al. Genomic association analysis of common variants influencing antihypertensive response to hydrochlorothiazide. Hypertension. 2013;62(2):391–7.
Frau F et al. Genome-wide association study identifies CAMKID variants involved in blood pressure response to losartan: the SOPHIA study. Pharmacogenomics. 2014;15(13):1643–52.
Hiltunen TP et al. Pharmacogenomics of hypertension: a genome-wide, placebo-controlled cross-over study, using four classes of antihypertensive drugs. J Am Heart Assoc. 2015;4(1):e001521.
Chittani M et al. TET2 and CSMD1 genes affect SBP response to hydrochlorothiazide in never-treated essential hypertensives. J Hypertens. 2015;33(6):1301–9.
Menni C. Blood pressure pharmacogenomics: gazing into a misty crystal ball. J Hypertens. 2015;33(6):1142–3.
Ji W et al. Rare independent mutations in renal salt handling genes contribute to blood pressure variation. Nat Genet. 2008;40(5):592–9.
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David S. Geller declares that he has no conflict of interest.
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Geller, D.S. New Developments in the Genetics of Hypertension: What Should Clinicians Know?. Curr Cardiol Rep 17, 122 (2015). https://doi.org/10.1007/s11886-015-0664-y
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DOI: https://doi.org/10.1007/s11886-015-0664-y