Large-scale gene-centric analysis identifies polymorphisms for resistant hypertension

Vanessa Fontana, Caitrin W McDonough, Yan Gong, Nihal M El Rouby, Ana Caroline C Sá, Kent D Taylor, Y-D Ida Chen, John G Gums, Arlene B Chapman, Stephen T Turner, Carl J Pepine, Julie A Johnson, Rhonda M Cooper-DeHoff, Vanessa Fontana, Caitrin W McDonough, Yan Gong, Nihal M El Rouby, Ana Caroline C Sá, Kent D Taylor, Y-D Ida Chen, John G Gums, Arlene B Chapman, Stephen T Turner, Carl J Pepine, Julie A Johnson, Rhonda M Cooper-DeHoff

Abstract

Background: Resistant hypertension (RHTN), defined by lack of blood pressure (BP) control despite treatment with at least 3 antihypertensive drugs, increases cardiovascular risk compared with controlled hypertension. Yet, there are few data on genetic variants associated with RHTN.

Methods and results: We used a gene-centric array containing ≈50 000 single-nucleotide polymorphisms (SNPs) to identify polymorphisms associated with RHTN in hypertensive participants with coronary artery disease (CAD) from INVEST-GENES (the INnternational VErapamil-SR Trandolapril STudy-GENEtic Substudy). RHTN was defined as BP≥140/90 on 3 drugs, or any BP on 4 or more drugs. Logistic regression analysis was performed in European Americans (n=904) and Hispanics (n=837), using an additive model adjusted for age, gender, randomized treatment assignment, body mass index, principal components for ancestry, and other significant predictors of RHTN. Replication of the top SNP was conducted in 241 European American women from WISE (Women's Ischemia Syndrome Evaluation), where RHTN was defined similarly. To investigate the functional effect of rs12817819, mRNA expression was measured in whole blood. We found ATP2B1 rs12817819 associated with RHTN in both INVEST European Americans (P-value=2.44×10(-3), odds ratio=1.57 [1.17 to 2.01]) and INVEST Hispanics (P=7.69×10(-4), odds ratio=1.76 [1.27 to 2.44]). A consistent trend was observed at rs12817819 in WISE, and the INVEST-WISE meta-analysis result reached chip-wide significance (P=1.60×10(-6), odds ratio=1.65 [1.36 to 1.95]). Expression analyses revealed significant differences in ATP2B1 expression by rs12817819 genotype.

Conclusions: The ATP2B1 rs12817819 A allele is associated with increased risk for RHTN in hypertensive participants with documented CAD or suspected ischemic heart disease.

Clinical trial registration url: www.clinicaltrials.gov; Unique identifiers: NCT00133692 (INVEST), NCT00000554 (WISE).

Keywords: genetics; hypertension; pharmacology; resistant hypertension.

© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1.
Figure 1.
Adjusted odds ratios and 95% CIs for resistant hypertension risk for ATP2B1 rs12817819 in INternational VErapamil SR Trandolapril STudy (INVEST) European Americans (EA), INVEST Hispanics, The Women's Ischemia Syndrome Evaluation (WISE) study, and meta‐analysis.
Figure 2.
Figure 2.
Genotype‐specific odds ratios and 95% CI for resistant hypertension risk for ATP2B1 rs12817819 in INternational VErapamil SR Trandolapril STudy (INVEST) European Americans (EA), INVEST Hispanics, and The Women's Ischemia Syndrome Evaluation (WISE). WISE AA genotype specific odds ratio and 95% CI was unestimable due to low genotype count (n=2).
Figure 3.
Figure 3.
Relative gene expression of ATP2B1 by rs12817819 genotype in 45 European Americans (EA) from the Pharmacogenomic Evaluation of Antihypertensive Responses study. Expression data are normalized to β‐2‐microglobulin. Error bars indicate standard error.

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