Abstract
Salt-sensitive hypertension is a complex disease associated with genetic factors. This study aimed to identify the association between 29 candidate single-nucleotide polymorphisms and salt-sensitive hypertension in a Han Chinese population. Sixty-three participants with salt-sensitive hypertension and 279 controls with salt-resistant hypertension were recruited. A modified Sullivan's acute oral saline load and diuresis shrinkage test was used to detect blood pressure salt sensitivity. Lifestyle risk factors were obtained via a questionnaire. We used the Sequenom Mass ARRAY Platform to genotype the 29 candidate single-nucleotide polymorphisms, and the cumulative genetic risk score was used to evaluate the joint genetic effect. The frequencies of eight genotypes and five alleles in CYP11B2, PRKG1, ADRB2, FGF5, SLC8A1 and BCAT1 genes differed significantly between the salt-sensitive and salt-resistant hypertension groups. Multiple logistic regression adjusted for age and sex showed that subjects carrying rs7897633-A (PRKG1), rs434082-A (SLC8A1) and rs1042714-G (ADRB2) risk alleles had 1.83-, 2.84- and 2.40-fold increased risk for salt-sensitive hypertension, respectively. Combined risk allele analysis using the cumulative genetic risk score showed that subjects carrying one risk had 2.30-fold increased risk, and those carrying 2–4 risks had 3.32-fold increased risk for salt-sensitive hypertension. Among 29 candidate single-nucleotide polymorphisms, rs7897633-A in PRKG1, rs434082-A in SLC8A1 and rs1042714-G in ADRB2 were significantly associated with salt-sensitive hypertension. A joint effect of single-nucleotide polymorphisms from different pathways contributed to a high risk of salt-sensitive hypertension.
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Introduction
Essential hypertension is one of the most common cardiovascular diseases that poses a considerable threat to human health. It is influenced by both genetic and environmental factors.1 High salt intake is the most important environmental risk factor for hypertension. Epidemiological, animal and clinical experimental studies consistently identify the positive correlation between high dietary sodium and elevated blood pressure (BP). The heterogeneity of BP response to sodium is defined as BP salt sensitivity. Salt-sensitive hypertension (SSH) can be regarded as an intermediate inheritance phenotype of essential hypertension with significant individual differences and ethnic specificity. Svetkey et al.2 examined 20 African-American families, and reported heritability of ~26–84% for mean arterial blood pressure (MAP) responses to salt sensitivity. The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) dietary feeding study indicated that ~39% of Chinese adults were salt-sensitive (SS).3 Salt sensitivity is more common in women, older individuals and those with higher readings of basic blood pressure.4 A 27-year cohort study reported that SSH is an independent risk factor for cardiovascular disease that increases morbidity and mortality.5
There has been substantial evidence to elucidate the genetic determinants underlying BP salt sensitivity,6, 7 but the associated pathologic mechanisms are not completely clear. Polygenic diseases such as hypertension are postulated to arise from epistatic interactions of many single-nucleotide polymorphisms (SNPs).8, 9 Most reports have focused on the renin–angiotensin–aldosterone system genes and their association with salt sensitivity, including the well-known angiotensin-converting-enzyme (ACE) insertion–deletion polymorphism,10 as well as the AGT M235T and G6A polymorphisms.11 ETBR 1065AA+GA (rs5351) has been reported to occur more frequently in salt-resistant (SR) hypertensive individuals, whereas ETBR 1065GG occurs more frequently in SS hypertensive individuals.12, 13
Genome-wide association studies (GWAS) and candidate gene studies have made great strides in delineating genomic mechanisms associated with BP regulation that have been well established in the following pathways: renin–angiotensin–aldosterone system,14 ion and water channels, transporters and exchangers,15 the endothelial system,16 intracellular messengers,17 the sympathetic nervous system,18 the apelin–APJ system19 and the kallikrein–kinin system,20 among many others21, 22 that are related to BP salt sensitivity. Until recently, three GWAS have been conducted on salt sensitivity. In a large family-based, dietary-based, genome-wide linkage scan study, the FAM84A gene SNP rs11674786 was significantly associated with diastolic blood pressure (DBP) and MAP responses, and rs16983422 of the VSNL1 gene was marginally associated with DBP and MAP responses. The present study provides new evidence of genetic factors that might be partially responsible for salt sensitivity of BP.23 One meta-analysis identified eight novel loci for BP phenotypes that were physically mapped in or near the following genes: PRMT6, CDCA7, PIBF1, ARL4C, IRAK1BP1, SALL1, TRPM8 and FBXL13. The polymorphism rs7577262 in the TRPM8 gene showed genome-wide significance for its association with systolic blood pressure (SBP), and the intronic FBXL13 marker rs17135875 achieved genome-wide significant associations with MAP responses to the cold pressor test.24 Another GWAS study on Caucasians with mild hypertension identified that SNPs located in the first intron of the cGMP-dependent protein kinase 1 (PRKG1) gene are associated with variations in DBP, whereas SLC24A3 and SLC8A1 are associated with variations in SBP following acute salt loading.25 Although GWAS are valuable for uncovering novel mechanisms underlying BP salt sensitivity, most of the findings require evidence of replication, and some biological pathways warrant further investigation.
In the present study, we used a modified Sullivan's acute salt loading and diuresis shrinkage test26, 27, 28 to identify the responses in BP salt sensitivity among a community of patients with essential hypertension in Beijing. We summarized the pathologic pathway of 29 candidate SNPs in SSH. Literature retrieval of association studies on candidate SNPs and previous GWAS results of salt sensitivity were also used to validate the effects of candidate SNPs with environmental risk factors of SSH.
Methods
Subjects
Sixty-three individuals with SSH and 279 individuals with SR hypertension (SRH) were recruited from a community of individuals with essential hypertension in Beijing, in a case–control study. The essential hypertension group was defined as those with SBP⩾140 mm Hg and/or DBP⩾90 mm Hg, and included those who used antihypertensive medications, according to the 2010 Chinese guidelines for the management of essential hypertension.29 Participants who were pregnant or who abused alcohol, as well as those with cardiovascular disease, heart failure, cerebrovascular disease, secondary hypertension, resistant hypertension or Liddle syndrome were excluded. The study was approved by the Ethical Committee of Capital Medical University, Beijing, China. All participants gave informed consent before participation.
Measurement of anthropometric parameters
Information on the history of hypertension, physical examination, personal behavior and use of antihypertensive medications was obtained, using a standard questionnaire. Body weight, height, waist circumference, hip circumference, SBP and DBP were measured by well-trained community doctors. Blood pressure was measured using a mercury sphygmomanometer on the right arm of each participant, who was seated in a comfortable position after at least 5 min rest.
After overnight fasting, peripheral venous blood samples were collected the following morning, to evaluate biochemical parameters, such as fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Daily sodium intake was evaluated using a food frequency questionnaire and 24-h urinary Na excretion.
Acute oral saline load test
A modified Sullivan's acute salt loading and diuresis shrinkage test was used to identify SSH and SRH.26, 27, 28 The modified Sullivan's acute salt loading and diuresis shrinkage test entailed the following process: for the first day, an acute salt load of 1 L of oral saline (155 mmol NaCl) was administered within 30 min in the morning. After 2 h, the diuresis shrinkage test was performed and each patient was administered oral furosemide (40 mg). Blood pressure was measured using a standard procedure three times at 5-min intervals, before loading, 2 h after the salt load test and 2 h after the diuresis shrinkage test. The mean blood pressure values of the three readings were used for further analysis. MAP was calculated according to the equation: MAP=(SBP+2 × DBP)/3.30 Individuals with an increased MAP of at least 5 mm Hg after 2 h of the salt load, or those with a reduction by more than 10 mm Hg after 2 h of the diuresis shrinkage test, were categorized as SS, whereas all other individuals were categorized as SR.
Tag-SNP selection
The selection of 29 candidate SNPs was performed in a comprehensive manner that included the evaluation of pathologic mechanisms of SSH, and retrieval of published epidemiologic studies that used evidence-based methods and GWAS results. We downloaded data on the Han Chinese population SNPs from the database of the international HapMap Project (HapMap Data Rel 24/phase II Nov08, on NVBI B36 assembly, dbSNP b126). To achieve a power ⩾80% in the present study, the SNPs that were significantly associated with SSH, and minor allele frequencies>0.05 in the Chinese population of the HapMap database, were selected by the Haploview 4.0 software (version 4.0; Mark Daly’s Laboratory, Broad Institute; http://sourceforge.net/projects/haploview/).
DNA extraction and genotyping
Genomic DNA was isolated from peripheral blood leukocytes, using the QIAamp DNA Blood Mini Kit (Tiangen Inc., Hilden, Germany) according to the manufacturer’s instructions. The concentration and purity of the isolated DNA were measured using the NanoDrop 2000 spectrophotometer (Thermo Fisher Scientific, Waltham, MA, USA), according to the manufacturer’s instructions. If the value of OD260/OD280 was between 1.7 and 2.0, and the DNA concentration was >10 ng μl−1, the result was considered more favorable. All candidate SNPs were genotyped on the Sequenom Mass ARRAY Platform (Sequenom, San Diego, CA, USA). Based on the manufacturer’s instructions, the entire process included multiplex PCR amplification, shrimp alkaline phosphatase treatment, iPLEX primer extension, cleaning of the resin, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and data analysis.31, 32
Statistical analysis
Statistical analyses were carried out using SPSS version 19.0 for Windows (SPSS, Chicago, IL, USA). The independent two-sample t-test was used for continuous variables with normal distribution, and the rank-sum test was used to analyze variables with non-normal distribution. The χ2 test was used to analyze Hardy–Weinberg equilibrium, and to compare the distributions of allelic and genotypic frequencies. The association between a polymorphism and SSH at a single locus was analyzed by multiple logistic regression adjusted for age and sex. A multivariable model was developed based on 1000 bootstrap samples on the original data, using multiple logistic regression analysis. A cumulative genetic risk score (cGRS) was applied, to analyze the combined effect of multiple SNPs on SSH. This score was calculated for each individual, by adding the number of risk alleles at each locus. A value of 2 was assigned to subjects with double risk alleles, and a value of 0 was assigned to all other subjects. The cGRS ranged from 0 to 8 among the subjects. Multiple logistic regression was used to evaluate the association between cGRS and SSH as a binary dependent variable. Power analysis was performed, using the Quanto software version 1.2.4 (University of Southern California, Los Angeles, CA, USA). Assuming a minor allele frequency of 0.15 and disease prevalence of 20.0%, statistical power >80% was used to detect genetic effects at an odds ratio of 2.03–3.53 in an additive model. The significance level in all the tests was P<0.05 for two sides. The analysis was carried out using additive, dominant, recessive and allele models.
Results
Baseline characteristics of the subjects
The baseline characteristics of the study subjects are presented in Table 1. The average age of the SSH group was higher than that of the SRH group (P=0.038). No significant differences in sex, body mass index level, baseline mean arterial blood pressure, salt intake, 24-h urinary sodium content and 24-h urinary potassium content were noted between the two groups.
Association between candidate SNPs and SSH
We genotyped 29 SNPs in 342 participants (SSH/SRH=63/279), and the distribution of genotypes and alleles for the 29 SNPs are listed in Table 2. No deviation from Hardy–Weinberg equilibrium was observed among these SNPs in the control group (P>0.05). Univariate analysis indicated that the frequencies of eight SNPs in the six genes CYP11B2, PRKG1, ADRB2, FGF5, SLC8A1 and BCAT1, and five alleles in the CYP11B2, PRKG1, ADRB2, FGF5 and SLC8A1 genes differed significantly between the SSH and SRH groups. After adjustments for age and sex, only the SNP rs7961152 in the BCAT1 gene failed to show any significant differences (Table 3).
Multivariable analysis of candidate SNPs in SSH
Multiple logistic regression analysis adjusted for age and sex revealed significant differences between the SSH and SRH groups in the frequencies of risk allelic distributions of rs7897633 (PRKG1) (P=0.027), rs434082 (SLC8A1) (P<0.001) and rs1042714 (ADRB2) (P=0.004). Carriers of rs7897633-A, rs434082-A and rs1042714-G risk alleles had a 1.83-fold (OR (95% CI): 1.07–3.14), 2.84-fold (OR (95% CI): 1.65–4.87) and 2.40-fold (OR (95% CI): 1.32–4.35) increased risk for SSH, respectively. Older females showed greater risk for SSH. The final logit model was (P=SSH)=0.03 × age+0.58 × sex+0.61 × PRKG1 rs7897633-A allele+1.04 × SLC8A1 rs434082-A allele+0.88 × ADRB2 rs1042714-G allele−4.85. After 1000 bootstrap samples were used to confirm the results of multiple logistic regression based on increasing the sample size, similar results were observed (Table 4).
A cGRS was applied to analyze the combined effect of multiple SNPs on SSH. The risk score for each individual was calculated by adding the number of risk alleles (1-risk indicated subjects with one homozygous risk genotype of more than five significant alleles; 2–4 risks indicated subjects with more than two homozygous risk genotypes; 0-risk indicated subjects without homozygous risk genotypes). In multiple logistic regression analysis adjusted for age and sex, subjects carrying 1-risk (with rs1799998/CC, rs7897633/AA, rs1904694/GG, rs434082/AA or rs1042714/GG) had a 2.30-fold (OR (95% CI): 1.18–4.48, P=0.014) increased risk for SSH, whereas the risk was increased 3.32-fold (OR (95% CI): 95% CI 1.51–7.30, P=0.003) among subjects carrying 2–4 risks (Table 3).
Discussion
Epidemiologic studies have shown that genetic factors can considerably affect blood pressure. Kawasaki et al.33 and Weinberger34 were among the first to recognize the heterogeneity of BP response to sodium, and proposed the concept of salt sensitivity in humans. The GenSalt study, which is the largest dietary sodium-feeding study to date, was designed to examine gene–sodium interactions associated with BP.35 Candidate gene studies have made considerable progress in revealing the genetic mechanisms of BP response to salt intake. Extensive efforts have been made to identify the genes in different pathways, such as renin–angiotensin–aldosterone system, ion and water channels, transporters and exchangers, the endothelial system, apelin–APJ system, sympathetic nervous system, intracellular messengers and the kallikrein–kinin system.36 Several studies have tried to the identify genetic factors associated with salt sensitivity; however, there have been inconsistent results.12 Genetic studies in SSH generally focus on exploration of the functions of renal sodium excretion and its related regulation genes. We first systematically reviewed the literature to select candidate genes involved in SSH, and then explored the association between candidate genes and SSH. Seven SNPs were verified as having an association with the development of salt sensitivity: rs1799998 in CYP11B2; rs7897633 and rs1904694 in PRKG1; rs434082 and rs11893826 in SLC8A1; rs1042714 in ADRB2; and rs16998073 in FGF5.
The aldosterone synthase gene, CYP11B2, encodes a cytochrome P450 enzyme that is involved in the terminal steps of aldosterone synthesis in cells of the zona glomerulosa in the adrenal glands of humans, and its expression is regulated by angiotensin II and potassium.37 One polymorphism in this gene, rs1799998, is located 344 bp upstream. Studies have shown that the C allele binds to the steroidogenic factor-1 site, five times stronger than it does to the T allele,38 a phenomenon that might modify the effects of aldosterone, and affect the cardiovascular system. A dietary intervention study that entailed a 7-day low-sodium regimen followed by a 7-day high-sodium regimen reported no significant associations between this SNP and salt sensitivity of blood pressure.39 A population-based, cross-sectional study suggested that the frequency of the C allele was significantly lower in people of African origin than in those of white and South Asian origins.40 Furthermore, the TT genotype was associated with higher plasma aldosterone levels, and higher SBP and DBP than was the CC genotype. These results might reflect an association with various races. Iwai et al.41 reported that the CYP11B2 rs1799998 polymorphism in a Japanese population is associated with salt sensitivity. In the present study, the participants who carried the CC genotype and C allele were at greater risk of SSH, as compared with those with the TT genotype and T allele.
Many researchers suggest that SSH is related to a disordered mechanism of sodium and calcium ion transport and impaired endothelial function. After salt loading, inhibition of the PRKG1 isoenzyme reduces the activity of nitric oxide, a process that affects the regulation of vascular smooth muscle cells. The PRKG1 gene might influence BP either by increasing the concentration of free intracellular calcium ions or increasing the sensitivity of contractile cells to calcium ions. Calcium ions have an important role in the control of vascular tone, and make a significant contribution to the regulation of systemic blood pressure.42, 43 PRKG1 proteins have central roles in the regulation of cardiovascular and neuronal functions, relaxation of smooth muscle tone,44, 45 prevention of platelet aggregation and modulation of cell growth. The PRKG1 gene is most strongly expressed in all types of smooth muscle, platelets, cerebellar Purkinje cells, hippocampal neurons and the lateral amygdalae.46 The pathologic effects of the PRKG1 gene on SSH have not been clarified. In 2011, Citterio et al.25 conducted a genome-wide association study in Italians, and reported a strong association between a cluster of tag-SNPs mapped in the first introns of the PRKG1 gene (rs7897633) and DBP after acute salt loading. On the other hand, a subsequent study by Citterio et al.47 demonstrated that the PRKG1 risk haplotype GAT (rs1904694, rs7897633 and rs7905063) is associated with a rightward shift of the pressure–natriuresis curve compared with the ACC haplotype, indicating that PRKG1 risk alleles are associated with salt sensitivity related to a loss of inhibitory control of renal Na+ reabsorption, suggestive of a blunt pressure–natriuresis response.
SLC8A1, a gene that codes for the Na+/Ca2+ exchanger type 1, is involved in the control of peripheral vascular resistance. SLC8A1 affects essential hypertension and salt sensitivity by regulating intracellular Ca2+ and the tubular response to salt loading.48 Citterio et al.25 also focused on this gene, and reported that rs434082 was associated with variations in SBP. The rs11893826 polymorphism was significantly associated with urinary Ca2+ excretion 2 h after acute salt loading, suggesting that reduced Ca2+ excretion could affect BP response. Indeed, we verified that the polymorphic locus rs434082 was significantly associated with SSH. Subjects who carried the rs434082-A allele and the AA/GA genotype were at high risk for salt sensitivity that might have been influenced by the regulation of Ca2+ transport.
ADRB2 encodes the β-2-adrenergic receptor, which is a member of the G-protein-coupled receptor superfamily. This receptor is directly associated with one of its ultimate effectors, the class C L-type calcium channel. The ADRB2 gene is strongly implicated in the regulation of blood pressure. In an African-American sib-pairs study, preliminary evidence of a link between the ADRB2 gene and salt sensitivity was reported.49 In Dietary Approaches to Stop Hypertension-sodium trials,20 the association between two SNPs of ADRB2 (rs1042713 and rs1042714) and BP response to sodium intake, strongly suggests that this locus modulates dietary sodium sensitivity. Consistent with the present results, Pojoga et al.18 reported that salt sensitivity is associated with the A allele of rs1042713 and the C allele of rs1042714.
FGF5 is a member of the fibroblast growth factor (FGF) family that mediates a variety of biological processes, including embryonic development, cell growth, morphogenesis, tissue repair and tumor growth and invasion. A Han Chinese population study suggested that variation in upstream regions of the FGF5 gene was associated with altered susceptibility to essential hypertension, and reported that individuals with rs16998073 had a 72% increased risk for hypertension under a codominant model.50 Effects of FGF5-rs16998073 on SBP and essential hypertension were significantly more pronounced in Han Chinese than in white Europeans.51 However, few studies have focused on the association between rs16998073 in FGF5 and SSH. Rhee et al.52 reported that rs16998073 in FGF5 was associated with the development of salt sensitivity in a Korean population. Our study also demonstrated that rs16998073 might have a role in salt sensitivity.
A GRS is widely used for the prediction of diabetes,53 breast cancer54 and cardiovascular disease.55, 56 It is especially useful in earlier life, when knowledge of other risk factors is limited.53 In the present study, it was used to combine the effects of five SNPs on SSH and could provide a statistically significant improvement over the existing model. We used a modified Sullivan's acute salt loading and diuresis shrinkage test to determine the BP response to salt sensitivity. Previously, there has been no gold standard to identify salt sensitivity. A variety of protocols have been used to test for salt sensitivity, including acute salt loading,57 and chronic low- and high-sodium dietary intervention.3 However, the established methods of salt sensitivity determination are too complicated for screening at the level of the population. A greater number of studies that focus on an easier, more acceptable method of salt sensitivity testing is crucial. Some limitations affected the present study. First, our study sample was relatively small. Thus, a multivariable model was developed based on 1000 bootstrap samples. This method was used to perform the internal validation of predictive accuracy. Second, all associations suggested in this study were derived from a population-genetics-based approach supported by statistical analyses, and the underlying biological mechanisms of SSH require further research.
In conclusion, the present study aimed to identify the association between 29 candidate SNPs and SSH in a Han Chinese population. Eight genotypes and five alleles in the CYP11B2, PRKG1, ADRB2, FGF5, SLC8A1 and BCAT1 genes showed significant differences between the SSH and SRH groups. A joint effect of SNPs from different pathways contributed to a higher risk of SSH. The polymorphisms rs7897633-A in the PRKG1 gene, rs434082-A in the SLC8A1 gene and rs1042714-G in the ADRB2 gene, in addition to increasing age and the female sex, were all risk factors for SSH. Subjects carrying 2–4 risks had 3.32-fold increased risk compared with those without risk alleles for SSH.
References
Michael SK, Surks HK, Wang Y, Zhu Y, Blanton R, Jamnongjit M, Aronovitz M, Baur W, Ohtani K, Wilkerson MK, Bonev AD, Nelson MT, Karas RH, Mendelsohn ME . High blood pressure arising from a defect in vascular function. Proc Natl Acad Sci USA 2008; 105: 6702–6707.
Svetkey LP, McKeown SP, Wilson AF . Heritability of salt sensitivity in black Americans. Hypertension 1996; 28: 854–858.
Chen J . Sodium sensitivity of blood pressure in Chinese populations. Curr Hypertens Rep 2010; 12: 127–134.
He J, Gu D, Chen J, Jaquish CE, Rao DC, Hixson JE, Chen JC, Duan X, Huang JF, Chen CS, Kelly TN, Bazzano LA, Whelton PK . Gender difference in blood pressure responses to dietary sodium intervention in the GenSalt study. J Hypertens 2009; 27: 48–54.
Weinberger MH, Fineberg NS, Fineberg SE, Weinberger M . Salt sensitivity, pulse pressure, and death in normal and hypertensive humans. Hypertension 2001; 37: 429–432.
Liu X, Wang W, Chen W, Jiang X, Zhang Y, Wang Z, Yang J, Jones JE, Jose PA, Yang Z . Regulation of blood pressure, oxidative stress and AT1R by high salt diet in mutant human dopamine D5 receptor transgenic mice. Hypertens Res 2015; 38: 394–399.
Okamura H, Doi M, Goto K, Kojima R . Clock genes and salt-sensitive hypertension: a new type of aldosterone-synthesizing enzyme controlled by the circadian clock and angiotensin II. Hypertens Res 2016; 39: 681–687.
Manolio TA, Collins FS, Cox NJ, Goldstein DB, Hindorff LA, Hunter DJ, McCarthy MI, Ramos EM, Cardon LR, Chakravarti A, Cho JH, Guttmacher AE, Kong A, Kruglyak L, Mardis E, Rotimi CN, Slatkin M, Valle D, Whittemore AS, Boehnke M, Clark AG, Eichler EE, Gibson G, Haines JL, Mackay TF, McCarroll SA, Visscher PM . Finding the missing heritability of complex diseases. Nature 2009; 461: 747–753.
Mell B, Abdul-Majeed S, Kumarasamy S, Waghulde H, Pillai R, Nie Y, Joe B . Multiple blood pressure loci with opposing blood pressure effects on rat chromosome 1 in a homologous region linked to hypertension on human chromosome 15. Hypertens Res 2015; 38: 61–67.
Poch E, Gonzalez D, Giner V, Bragulat E, Coca A, de La Sierra A . Molecular basis of salt sensitivity in human hypertension. Evaluation of renin–angiotensin–aldosterone system gene polymorphisms. Hypertension 2001; 38: 1204–1209.
Norat T, Bowman R, Luben R, Welch A, Khaw KT, Wareham N, Bingham S . Blood pressure and interactions between the angiotensin polymorphism AGT M235T and sodium intake: a cross-sectional population study. Am J Clin Nutr 2008; 88: 392–397.
Strazzullo P, Galletti F . Genetics of salt-sensitive hypertension. Curr Hypertens Rep 2007; 9: 25–32.
Beeks E, Kessels AG, Kroon AA, van der Klauw MM, de Leeuw PW . Genetic predisposition to salt-sensitivity: a systematic review. J Hypertens 2004; 22: 1243–1249.
Pamies-Andreu E, Ramirez-Lorca R, Stiefel Garcia-Junco P, Muniz-Grijalbo O, Vallejo-Maroto I, Garcia Morillo S, Miranda-Guisado ML, Ortiz JV, Carneado de la Fuente J . Renin–angiotensin–aldosterone system and G-protein beta-3 subunit gene polymorphisms in salt-sensitive essential hypertension. J Hum Hypertens 2003; 17: 187–191.
Zhao Q, Gu D, Hixson JE, Liu DP, Rao DC, Jaquish CE, Kelly TN, Lu F, Ma J, Mu J, Shimmin LC, Chen J, Mei H, Hamm LL, He J . Common variants in epithelial sodium channel genes contribute to salt sensitivity of blood pressure: The GenSalt study. Circ Cardiovasc Genet 2011; 4: 375–380.
Castejon AM, Bracero J, Hoffmann IS, Alfieri AB, Cubeddu LX . NAD(P)H oxidase p22phox gene C242T polymorphism, nitric oxide production, salt sensitivity and cardiovascular risk factors in Hispanics. J Hum Hypertens 2006; 20: 772–779.
Manunta P, Maillard M, Tantardini C, Simonini M, Lanzani C, Citterio L, Stella P, Casamassima N, Burnier M, Hamlyn JM, Bianchi G . Relationships among endogenous ouabain, alpha-adducin polymorphisms and renal sodium handling in primary hypertension. J Hypertens 2008; 26: 914–920.
Pojoga L, Kolatkar NS, Williams JS, Perlstein TS, Jeunemaitre X, Brown NJ, Hopkins PN, Raby BA, Williams GH . Beta-2 adrenergic receptor diplotype defines a subset of salt-sensitive hypertension. Hypertension 2006; 48: 892–900.
Zhao Q, Hixson JE, Rao DC, Gu D, Jaquish CE, Rice T, Shimmin LC, Chen J, Cao J, Kelly TN, Hamm LL, He J . Genetic variants in the apelin system and blood pressure responses to dietary sodium interventions: a family-based association study. J Hypertens 2010; 28: 756–763.
Svetkey LP, Harris EL, Martin E, Vollmer WM, Meltesen GT, Ricchiuti V, Williams G, Appel LJ, Bray GA, Moore TJ, Winn MP, Conlin PR . Modulation of the BP response to diet by genes in the renin-angiotensin system and the adrenergic nervous system. Am J Hypertens 2011; 24: 209–217.
Manunta P, Lavery G, Lanzani C, Braund PS, Simonini M, Bodycote C, Zagato L, Delli Carpini S, Tantardini C, Brioni E, Bianchi G, Samani NJ . Physiological interaction between alpha-adducin and WNK1-NEDD4L pathways on sodium-related blood pressure regulation. Hypertension 2008; 52: 366–372.
Eap CB, Bochud M, Elston RC, Bovet P, Maillard MP, Nussberger J, Schild L, Shamlaye C, Burnier M . CYP3A5 and ABCB1 genes influence blood pressure and response to treatment, and their effect is modified by salt. Hypertension 2007; 49: 1007–1014.
Mei H, Gu D, Hixson JE, Rice TK, Chen J, Shimmin LC, Schwander K, Kelly TN, Liu DP, Chen S, Huang JF, Jaquish CE, Rao DC, He J . Genome-wide linkage and positional association study of blood pressure response to dietary sodium intervention: the GenSalt Study. Am J Epidemiol 2012; 176 (Suppl 7): S81–S90.
He J, Kelly TN, Zhao Q, Li H, Huang J, Wang L, Jaquish CE, Sung YJ, Shimmin LC, Lu F, Mu J, Hu D, Ji X, Shen C, Guo D, Ma J, Wang R, Shen J, Li S, Chen J, Mei H, Chen CS, Chen S, Chen J, Li J, Cao J, Lu X, Wu X, Rice TK, Gu CC, Schwander K, Hamm LL, Liu D, Rao DC, Hixson JE, Gu D . Genome-wide association study identifies 8 novel loci associated with blood pressure responses to interventions in Han Chinese. Circ Cardiovasc Genet 2013; 6: 598–607.
Citterio L, Simonini M, Zagato L, Salvi E, Delli Carpini S, Lanzani C, Messaggio E, Casamassima N, Frau F, D'Avila F, Cusi D, Barlassina C, Manunta P . Genes involved in vasoconstriction and vasodilation system affect salt-sensitive hypertension. PLoS ONE 2011; 6: e19620.
Sullivan JM . Salt sensitivity. Definition, conception, methodology, and long-term issues. Hypertension 1991; 17 (Suppl): I61–I68.
Luft FC, Grim CE, Willis LR, Higgins JT Jr, Weinberger MH . Natriuretic response to saline infusion in normotensive and hypertensive man. The role of renin suppression in exaggerated natriuresis. Circulation 1977; 55: 779–784.
Mu Jianjun LZ, Dingyi Yang, Xianglin Xu, Jixin Hu, Yuming Li, Wang Zhexun . Erythrocyte sodium-lithium countertransport and urinary kallikrein excretion in children with hypertension. Chin J Hypertens 1993; 1: 76–79.
Writing Group of 2010 Chinese Guidelines for the Management of Hypertension. 2010 Chinese guidelines for the management of hypertension. Chin J Hypertens 2011; 19: 701–743.
Wain LV, Verwoert GC, O'Reilly PF, Shi G, Johnson T, Johnson AD, Bochud M, Rice KM, Henneman P, Smith AV, Ehret GB, Amin N, Larson MG, Mooser V, Hadley D, Dorr M, Bis JC, Aspelund T, Esko T, Janssens AC, Zhao JH, Heath S, Laan M, Fu J, Pistis G, Luan J, Arora P, Lucas G, Pirastu N, Pichler I, Jackson AU, Webster RJ, Zhang F, Peden JF, Schmidt H, Tanaka T, Campbell H, Igl W, Milaneschi Y, Hottenga JJ, Vitart V, Chasman DI, Trompet S, Bragg-Gresham JL, Alizadeh BZ, Chambers JC, Guo X, Lehtimaki T, Kuhnel B, Lopez LM, Polasek O, Boban M, Nelson CP, Morrison AC, Pihur V, Ganesh SK, Hofman A, Kundu S, Mattace-Raso FU, Rivadeneira F, Sijbrands EJ, Uitterlinden AG, Hwang SJ, Vasan RS, Wang TJ, Bergmann S, Vollenweider P, Waeber G, Laitinen J, Pouta A, Zitting P, McArdle WL, Kroemer HK, Volker U, Volzke H, Glazer NL, Taylor KD, Harris TB, Alavere H, Haller T, Keis A, Tammesoo ML, Aulchenko Y, Barroso I, Khaw KT, Galan P, Hercberg S, Lathrop M, Eyheramendy S, Org E, Sober S, Lu X, Nolte IM, Penninx BW, Corre T, Masciullo C, Sala C, Groop L, Voight BF, Melander O, O'Donnell CJ, Salomaa V, d'Adamo AP, Fabretto A, Faletra F, Ulivi S, Del Greco F, Facheris M, Collins FS, Bergman RN, Beilby JP, Hung J, Musk AW, Mangino M, Shin SY, Soranzo N, Watkins H, Goel A, Hamsten A, Gider P, Loitfelder M, Zeginigg M, Hernandez D, Najjar SS, Navarro P, Wild SH, Corsi AM, Singleton A, de Geus EJ, Willemsen G, Parker AN, Rose LM, Buckley B, Stott D, Orru M, Uda M, van der Klauw MM, Zhang W, Li X, Scott J, Chen YD, Burke GL, Kahonen M, Viikari J, Doring A, Meitinger T, Davies G, Starr JM, Emilsson V, Plump A, Lindeman JH, Hoen PA, Konig IR, Felix JF, Clarke R, Hopewell JC, Ongen H, Breteler M, Debette S, Destefano AL, Fornage M, Mitchell GF, Smith NL, Holm H, Stefansson K, Thorleifsson G, Thorsteinsdottir U, Samani NJ, Preuss M, Rudan I, Hayward C, Deary IJ, Wichmann HE, Raitakari OT, Palmas W, Kooner JS, Stolk RP, Jukema JW, Wright AF, Boomsma DI, Bandinelli S, Gyllensten UB, Wilson JF, Ferrucci L, Schmidt R, Farrall M, Spector TD, Palmer LJ, Tuomilehto J, Pfeufer A, Gasparini P, Siscovick D, Altshuler D, Loos RJ, Toniolo D, Snieder H, Gieger C, Meneton P, Wareham NJ, Oostra BA, Metspalu A, Launer L, Rettig R, Strachan DP, Beckmann JS, Witteman JC, Erdmann J, van Dijk KW, Boerwinkle E, Boehnke M, Ridker PM, Jarvelin MR, Chakravarti A, Abecasis GR, Gudnason V, Newton-Cheh C, Levy D, Munroe PB, Psaty BM, Caulfield MJ, Rao DC, Tobin MD, Elliott P, van Duijn CM . Genome-wide association study identifies six new loci influencing pulse pressure and mean arterial pressure. Nat Genet 2011; 43: 1005–1011.
Soderlund-Strand A, Dillner J, Carlson J . High-throughput genotyping of oncogenic human papilloma viruses with MALDI-TOF mass spectrometry. Clin Chem 2008; 54: 86–92.
Schaeffeler E, Zanger UM, Eichelbaum M, Asante-Poku S, Shin JG, Schwab M . Highly multiplexed genotyping of thiopurine s-methyltransferase variants using MALD-TOF mass spectrometry: reliable genotyping in different ethnic groups. Clin Chem 2008; 54: 1637–1647.
Kawasaki T, Delea CS, Bartter FC, Smith H . The effect of high-sodium and low-sodium intakes on blood pressure and other related variables in human subjects with idiopathic hypertension. Am J Med 1978; 64: 193–198.
Weinberger MH . Salt sensitivity of blood pressure in humans. Hypertension 1996; 27: 481–490.
Group. GCR. GenSalt: rationale, design, methods and baseline characteristics of study participants. J Hum Hypertens 2007; 21: 639–646.
Kelly TN, He J . Genomic epidemiology of blood pressure salt sensitivity. J Hypertens 2012; 30: 861–873.
Clyne CD, Zhang Y, Slutsker L, Mathis JM, White PC, Rainey WE . Angiotensin II and potassium regulate human CYP11B2 transcription through common cis-elements. Mol Endocrinol 1997; 11: 638–649.
Bassett MH, Zhang Y, Clyne C, White PC, Rainey WE . Differential regulation of aldosterone synthase and 11beta-hydroxylase transcription by steroidogenic factor-1. J Mol Endocrinol 2002; 28: 125–135.
Gu D, Kelly TN, Hixson JE, Chen J, Liu D, Chen JC, Rao DC, Mu J, Ma J, Jaquish CE, Rice TK, Gu C, Hamm LL, Whelton PK, He J . Genetic variants in the renin–angiotensin–aldosterone system and salt sensitivity of blood pressure. J Hypertens 2010; 28: 1210–1220.
Barbato A, Russo P, Siani A, Folkerd EJ, Miller MA, Venezia A, Grimaldi C, Strazzullo P, Cappuccio FP . Aldosterone synthase gene (CYP11B2) C-344 T polymorphism, plasma aldosterone, renin activity and blood pressure in a multi-ethnic population. J Hypertens 2004; 22: 1895–1901.
Iwai N, Kajimoto K, Tomoike H, Takashima N . Polymorphism of CYP11B2 determines salt sensitivity in Japanese. Hypertension 2007; 49: 825–831.
Lincoln TM, Dey N, Sellak H . Invited review: cGMP-dependent protein kinase signaling mechanisms in smooth muscle: from the regulation of tone to gene expression. J Appl Physiol (1985) 2001; 91: 1421–1430.
Geiselhoringer A, Werner M, Sigl K, Smital P, Worner R, Acheo L, Stieber J, Weinmeister P, Feil R, Feil S, Wegener J, Hofmann F, Schlossmann J . IRAG is essential for relaxation of receptor-triggered smooth muscle contraction by cGMP kinase. EMBO J 2004; 23: 4222–4231.
Surks HK, Mochizuki N, Kasai Y, Georgescu SP, Tang KM, Ito M, Lincoln TM, Mendelsohn ME . Regulation of myosin phosphatase by a specific interaction with cGMP-dependent protein kinase Ialpha. Science 1999; 286: 1583–1587.
Geiselhoringer A, Gaisa M, Hofmann F, Schlossmann J . Distribution of IRAG and cGKI-isoforms in murine tissues. FEBS Lett 2004; 575: 19–22.
Feil R, Holter SM, Weindl K, Wurst W, Langmesser S, Gerling A, Feil S, Albrecht U . cGMP-dependent protein kinase I, the circadian clock, sleep and learning. Commun Integr Biol 2009; 2: 298–301.
Citterio L, Ferrandi M, Delli Carpini S, Simonini M, Kuznetsova T, Molinari I, Dell' Antonio G, Lanzani C, Merlino L, Brioni E, Staessen JA, Bianchi G, Manunta P . cGMP-dependent protein kinase 1 polymorphisms underlie renal sodium handling impairment. Hypertension 2013; 62: 1027–1033.
Blaustein MP, Zhang J, Chen L, Song H, Raina H, Kinsey SP, Izuka M, Iwamoto T, Kotlikoff MI, Lingrel JB, Philipson KD, Wier WG, Hamlyn JM . The pump, the exchanger, and endogenous ouabain: signaling mechanisms that link salt retention to hypertension. Hypertension 2009; 53: 291–298.
Svetkey LP, Chen YT, McKeown SP, Preis L, Wilson AF . Preliminary evidence of linkage of salt sensitivity in black Americans at the beta 2-adrenergic receptor locus. Hypertension 1997; 29: 918–922.
Niu W, Zhang Y, Ji K, Gu M, Gao P, Zhu D . Confirmation of top polymorphisms in hypertension genome wide association study among Han Chinese. Clin Chim Acta 2010; 411: 1491–1495.
Liu C, Li H, Qi Q, Lu L, Gan W, Loos RJ, Lin X . Common variants in or near FGF5, CYP17A1 and MTHFR genes are associated with blood pressure and hypertension in Chinese Hans. J Hypertens 2011; 29: 70–75.
Rhee MY, Yang SJ, Oh SW, Park Y, Kim CI, Park HK, Park SW, Park CY . Novel genetic variations associated with salt sensitivity in the Korean population. Hypertens Res 2011; 34: 606–611.
Meigs JB, Shrader P, Sullivan LM, McAteer JB, Fox CS, Dupuis J, Manning AK, Florez JC, Wilson PW, D'Agostino RB Sr., Cupples LA . Genotype score in addition to common risk factors for prediction of type 2 diabetes. N Engl J Med 2008; 359: 2208–2219.
Wacholder S, Hartge P, Prentice R, Garcia-Closas M, Feigelson HS, Diver WR, Thun MJ, Cox DG, Hankinson SE, Kraft P, Rosner B, Berg CD, Brinton LA, Lissowska J, Sherman ME, Chlebowski R, Kooperberg C, Jackson RD, Buckman DW, Hui P, Pfeiffer R, Jacobs KB, Thomas GD, Hoover RN, Gail MH, Chanock SJ, Hunter DJ . Performance of common genetic variants in breast-cancer risk models. N Engl J Med 2010; 362: 986–993.
Lim NK, Lee JY, Lee JY, Park HY, Cho MC . The role of genetic risk score in predicting the risk of hypertension in the Korean population: Korean Genome and Epidemiology Study. PLoS ONE 2015; 10: e0131603.
Thanassoulis G, Peloso GM, Pencina MJ, Hoffmann U, Fox CS, Cupples LA, Levy D, D'Agostino RB, Hwang SJ, O'Donnell CJ . A genetic risk score is associated with incident cardiovascular disease and coronary artery calcium: the Framingham Heart Study. Circ Cardiovasc Genet 2012; 5: 113–121.
Felder RA, White MJ, Williams SM, Jose PA . Diagnostic tools for hypertension and salt sensitivity testing. Curr Opin Nephrol Hypertens 2013; 22: 65–76.
Acknowledgements
This work was financially supported by grants from the Natural Science Foundation of China (81373076, 81602908), Beijing Natural Science Foundation (7172023), the National Key Research and Development Program of China (2016YFC0900603) and the Importation and Development of High-Caliber Talents Project of Beijing Municipal Institutions (CIT&TCD201504088).
Author contributions
LZ designed the study, and wrote and revised the manuscript. ZL performed the analysis and interpretation of the data, and drafted the manuscript. HQ, BL and JW contributed to acquisition of the data (population studies) and reviewed the manuscript. KL and JZ contributed to acquisition of data (genetics) and reviewed the manuscript. HC, YY and YH provided technical support for the analysis of the data and critical revision of the manuscript. All authors read and approved the final manuscript.
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Liu, Z., Qi, H., Liu, B. et al. Genetic susceptibility to salt-sensitive hypertension in a Han Chinese population: a validation study of candidate genes. Hypertens Res 40, 876–884 (2017). https://doi.org/10.1038/hr.2017.57
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DOI: https://doi.org/10.1038/hr.2017.57
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