Genetics of Hypertension in Blacks

BACKGROUND: This community-based study in three geographically distinct populations of West African heritage with contrasting levels of hypertension risk was one of the first comprehensive examinations of the genetics of hypertension in African Americans. The study focused on the renin-angiotensin system (RAS) because it was the only physiological arm of blood pressure control for which candidate genes had been securely linked to the risk of hypertension. Polymorphisms at the angiotensinogen locus varied considerably between Blacks and whites. The documented Black:white differences in the RAS system emphasized the importance of determining whether RAS genes contributed to the excessively high risk of hypertension experienced by African Americans. The study generated unique information about the variability of the RAS loci in populations of West African heritage, and the contribution of this variability to hypertension risk. The data from the study, including the DNA specimens, also represented a valuable resource for future work on the genetics of hypertension in this important ethnic group. DESIGN NARRATIVE: The primary goals of this study were: 1) Determine the extent to which genetic variability of the RAS genes influenced the distribution of blood pressure (and of RAS intermediate phenotypes) within each population, and contrast the results across populations; 2) Use family studies, within each population, to determine the degree-of familial aggregation of blood pressure, and of the RAS intermediate phenotypes; 3) Use segregation analysis to determine the contribution of 'major genes' to the familial aggregation of blood pressure and of hypertension, and determine whether RAS genes cosegregate with hypertension, or with RAS intermediate phenotypes; 4) Evaluate whether the different prevalence of hypertension in each community reflected differences in their genetic background. The study sites included Ibadan, Nigeria, Kingston, Jamaica, and Maywood, IL. At each site, genetic and epidemiological data were collected from individuals, sampled as follows: individuals comprising 100 five- member structured family sets (proband, spouse, two sibs, one offspring, or half-sib), equally ascertained from the highest and lowest quartiles of the blood pressure distribution, as defined by an ongoing community-wide survey; unrelated singletons, also sampled equally from the highest and lowest blood pressure quartiles. The following measurements were obtained from all participants. Epidemiological variables: blood pressure, height, weight, waist/hip ratio, skinfolds, urine sodium/potassium and sociodemographic variables; Intermediate phenotypes: Plasma levels of angiotensinogen, renin and angiotensin-converting enzyme (ACE); Genotypes: A set of DNA polymorphisms at the four main RAS loci (angiotensinogen, renin, ACE and the angiotensin II-type l receptor). The study was renewed in FY 2000. To further elucidate the environmental pathways, the investigators conducted a substudy cross-classifying participants on the major risk determinants (ie, obesity and sodium intake) and they examined gene-environment interactions directly. They used a genome scan in linkage analysis to identify new chromosomal regions of interest. They also examine two new candidate loci (adducin and beta-2 adrenergic receptor) and conducted association studies using single nucleotide polymorphisms. They used the full range of analytic tools, including segregation, linkage and cladistic analysis. The study was renewed again in FY 2005 to : supplement evidence of hypertension causation on chromosomes 6,7, and 11 with a new set of dense markers and to search for positional candidate genes for hypertension at the two best regions; identify the genes under the linkage peak(s), find appropriate single nucleotide polymorphisms for a frequency of greater than 10% and conduct association/linkage disequilibrium mapping; replicate these findings in additional case-control studies and assess potential gene-environment interactions.