Association of variants in NEDD4L with blood pressure response and adverse cardiovascular outcomes in hypertensive patients treated with thiazide diuretics

Abstract

Objective: Single-nucleotide polymorphisms (SNPs) in NEDD4L may influence the ability of the NEDD4L protein to reduce epithelial sodium channel expression. A variant in NEDD4L, rs4149601, was associated with antihypertensive response and cardiovascular outcomes during treatment with thiazide diuretics and β-blockers in a Swedish population. We sought to further evaluate associations between NEDD4L polymorphisms, blood pressure response and cardiovascular outcomes with thiazide diuretics and β-blockers.

Methods: Four SNPs, rs4149601, rs292449, rs1008899 and rs75982813, were genotyped in 767 patients from the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) clinical trial and association was assessed with blood pressure response to hydrochlorothiazide and atenolol. One SNP, rs4149601, was also genotyped in 1345 patients from the International Verapmil SR Trandolapril Study (INVEST), and association was examined with adverse cardiovascular outcomes relative to hydrochlorothiazide treatment.

Results: Significant associations or trends were found between rs4149601, rs292449, rs75982813 and rs1008899 and decreases in blood pressure in whites on hydrochlorothiazide, and a significant association was observed with increasing copies of the GC rs4149601-rs292449 haplotype and greater blood pressure response to hydrochlorothiazide in whites (P = 0.0006 and 0.006, SBP and DBP, respectively). Significant associations were also seen with rs4149601 and an increased risk for adverse cardiovascular outcomes in whites not treated with hydrochlorothiazide [P = 0.022, odds ratio (95% confidence interval) = 10.65 (1.18-96.25)].

Conclusion: NEDD4L rs4149601, rs292449 and rs75982813 may be predictors for blood pressure response to hydrochlorothiazide in whites, and NEDD4L rs4149601 may be a predictor for adverse cardiovascular outcomes in whites not treated with hydrochlorothiazide.

Conflict of interest statement

Conflicts of interest: There are no conflicts of interest.

Figures

Figure 1

Blood pressure response by rs4149601 genotype in white patients treated with hydrochlorothiazide in PEAR. Solid gray bars indicate ΔSBP, and gray and white lined bars indicate ΔDBP. Values are shown as means ± standard error. Add: additive, Dom: dominant.

Figure 2

Blood pressure response by copy of rs4149601-rs292449 GC haplotype in white patients treated with hydrochlorothiazide in PEAR. Solid gray bars indicate ΔSBP, and gray and white lined bars indicate ΔDBP. Values are shown as means ± standard error. Add: additive.

Figure 3

Effect of rs4149601 and hydrochlorothiazide treatment on the risk of the primary outcome in INVEST. The gray square point estimates correspond to HCTZ-treated individuals, and the black circle point estimates correspond to individuals not treated with HCTZ (No HCTZ).