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The genetics of blood pressure regulation and its target organs from association studies in 342,415 individuals

Abstract

To dissect the genetic architecture of blood pressure and assess effects on target organ damage, we analyzed 128,272 SNPs from targeted and genome-wide arrays in 201,529 individuals of European ancestry, and genotypes from an additional 140,886 individuals were used for validation. We identified 66 blood pressure–associated loci, of which 17 were new; 15 harbored multiple distinct association signals. The 66 index SNPs were enriched for cis-regulatory elements, particularly in vascular endothelial cells, consistent with a primary role in blood pressure control through modulation of vascular tone across multiple tissues. The 66 index SNPs combined in a risk score showed comparable effects in 64,421 individuals of non-European descent. The 66-SNP blood pressure risk score was significantly associated with target organ damage in multiple tissues but with minor effects in the kidney. Our findings expand current knowledge of blood pressure–related pathways and highlight tissues beyond the classical renal system in blood pressure regulation.

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Figure 1: Manhattan plots for SBP and DBP from the stage 4 Cardio-MetaboChip-wide meta-analysis.
Figure 2: Enrichment of DNase I–hypersensitive sites among blood pressure loci in 123 different cell types.

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Acknowledgements

We thank all the participants of this study for their contributions. Detailed acknowledgment of funding sources by study is provided in the Supplementary Note.

Author information

Authors and Affiliations

Authors

Consortia

Contributions

Analysis group. Design of secondary analyses: G.B.E., T. Ferreira, T.J., A.P.M., P.B.M., C.N.-C. Computation of secondary analyses: G.B.E., T. Ferreira, T.J., A.P.M., P.B.M., C.N.-C. Manuscript writing: A.C., G.B.E., T. Ferreira, T.J., A.P.M., P.B.M., C.N.-C. Study management: P.B.M., C.N.-C.

Cardio-MetaboChip or new GWAS. WGHS. Study phenotyping: P.M.R., D.I.C., L.M.R. Genotyping or analysis: P.M.R., D.I.C., L.M.R., F. Giulianini. Study PI: P.M.R. JUPITER. Study phenotyping: P.M.R., D.I.C., L.M.R. Genotyping or analysis: D.I.C., L.M.R., F. Giulianini. Study PI: P.M.R., D.I.C. deCODE. Study phenotyping: G.B. Genotyping or analysis: G.T. Study PI: K.S., U.T. GoDARTS. Study phenotyping: C.N.A.P., L.A.D., A.D.M., A.S.F.D. Genotyping or analysis: C.N.A.P., L.A.D., A.D.M., M.I.M., C.J.G., N.W.R. Study PI: C.N.A.P., A.D.M. KORA F3/F4. Study phenotyping: A.D., H. Schunkert, J.E. Genotyping or analysis: A.-K.P., M.M.-N., N.K., T.I. Study PI: H.-E.W., A. Peters. GLACIER. Study phenotyping: F.R., G.H. Genotyping or analysis: P.W.F., D. Shungin, I.B., S. Edkins, F.R. Study PI: P.W.F. B58C. Genotyping or analysis: S. Kanoni, K.E.S., Wellcome Trust Case Control Consortium, E.M., T. Ferreira, T.J. Study PI: P.D. MORGAM. Study phenotyping: K. Kuulasmaa, F. Gianfagna, A. Wagner, J. Dallongeville. Genotyping or analysis: M.F.H., F. Gianfagna. Study PI: J.V., J.F., A.E. SardiNIA. Study phenotyping: E.G.L. Genotyping or analysis: E.G.L., O. Meirelles, S. Sanna, R.N., A. Mulas, K.V.T. NFBC1986. Study phenotyping: M.-R.J., S. Sebert, K.-H.H., A.-L.H. Genotyping or analysis: M. Kaakinen, A.-L.H. Study PI: M.-R.J. DESIR. Genotyping or analysis: N.B.-N., L.Y., S.L. Study PI: P.F., N.B.-N., B.B. DILGOM. Study phenotyping: S.M. Genotyping or analysis: K. Kristiansson, M.P., A.S.H. Study PI: V.S. IMPROVE. Study phenotyping: D.B. Genotyping or analysis: R.J.S., K.G. Study PI: A. Hamsten, E. Tremoli. HyperGEN. Study phenotyping: S.C.H., D.C.R. Genotyping or analysis: A.C., V.P., G.B.E. Study PI: S.C.H. FENLAND (MetaboChip). Study phenotyping: R.J.F.L., J. Luan, N.J.W., K.K.O. Genotyping or analysis: R.J.F.L., J. Luan, N.J.W., K.K.O. Study PI: N.J.W. Whitehall II. Study phenotyping: M. Kumari. Genotyping or analysis: M. Kumari, S. Shah, C.L. Study PI: A.D.H., M. Kivimaki. LURIC. Genotyping or analysis: M.E.K., G. Delgado. Study PI: W.M. MESA. Study phenotyping: W.P. Genotyping or analysis: W.P., X.G., J.Y., D.V., K.D.T., J.I.R., Y.-D.C. Study PI: W.P. HUNT2. Study phenotyping: K. Kvaløy, J.H., O.L.H. Genotyping or analysis: A.U.J. Study PI: K.H. FINCAVAS. Genotyping or analysis: T.L., L.-P.L., K.N., M. Kähönen. Study PI: T.L., M. Kähönen. GenNet. Study phenotyping: R.S.C., A.B.W. Genotyping or analysis: A.C., V.P., M.X.S., D.E.A., G.B.E. Study PI: A.C., R.S.C., A.B.W. SCARFSHEEP. Study phenotyping: B.G. Genotyping or analysis: R.J.S. Study PI: A. Hamsten, U.d.F. DPS. Study phenotyping: J. Lindström. Genotyping or analysis: A.U.J., P.S.C. Study PI: J.T., M.U. DR's EXTRA. Study phenotyping: P.K. Genotyping or analysis: A.U.J., M.H. Study PI: R. Rauramaa, T.A.L. FIN-D2D 2007. Genotyping or analysis: A.U.J., L.L.B. Study PI: J. Saltevo, L.M. METSIM. Study phenotyping: H.M.S. Genotyping or analysis: A.U.J., A.S. Study PI: M.L., J.K. MDC-CVA. Study phenotyping: O. Melander. Genotyping or analysis: O. Melander, C.F. Study PI: O. Melander. BRIGHT. Study phenotyping: A.F.D., M.J.B., N.J.S., J.M.C. Genotyping or analysis: T.J., P.B.M. Study PI: M.J.C., A.F.D., M.J.B., N.J.S., J.M.C., P.B.M. NESDA. Study phenotyping: J.H.S. Genotyping or analysis: H. Snieder, I.M.N. Study PI: B.W.P. EPIC (MetaboChip). Study phenotyping: R.J.F.L., J. Luan, N.J.W. Genotyping or analysis: J. Luan, N.J.W. Study PI: N.J.W., K.-T.K. ELY. Study phenotyping: C.L., J. Luan, N.J.W. Genotyping or analysis: C.L., J. Luan, N.J.W. Study PI: N.J.W. DIAGEN. Study phenotyping: J.G., G.M. Genotyping or analysis: A.U.J., G.M. Study PI: P.E.H.S., S.R.B. GOSH. Study phenotyping: P.K.M., N.L.P. Genotyping or analysis: E.I., P.K.M., N.L.P., T. Fall. Study PI: E.I. Tromsø. Study phenotyping: T.W. Genotyping or analysis: A.U.J., A.J.S., N.N. Study PI: I.N.N. ADVANCE. Study phenotyping: T.L.A., C.I. Genotyping or analysis: T.L.A., E.L.S., T.Q. Study PI: T.L.A., T.Q., C.I. ULSAM. Study phenotyping: E.I., J. Sundstrom. Genotyping or analysis: E.I., N.E., J. Sundstrom, A.-C.S. Study PI: J. Sundstrom. PIVUS. Study phenotyping: L. Lind, J. Sundstrom. Genotyping or analysis: L. Lind, N.E., J. Sundstrom, T.A. Study PI: L. Lind, J. Sundstrom. MRC NSHD. Study phenotyping: D.K. Genotyping or analysis: A. Wong, J. Luan, D.K., K.K.O. Study PI: D.K. ASCOT. Study phenotyping: A.V. Stanton, N.P. Genotyping or analysis: T.J., M.J.C., P.B.M., E.P.A.v.I. Study PI: P.S., M.J.C. THISEAS. Genotyping or analysis: L.S.R., S. Kanoni, E.M., G. Kolovou. Study PI: G. Dedoussis, P.D. PARC. Study phenotyping: R.M.K. Genotyping or analysis: K.D.T., E. Theusch, J.I.R., X.L., M.O.G., Y.-D.I.C. Study PI: R.M.K. AMC-PAS. Genotyping or analysis: G.K.H., P.D., E.P.A.v.I. Study PI: G.K.H. CARDIOGENICS. Genotyping or analysis: S. Kanoni, A.H.G. Study PI: P.D., A.H.G., J.E., N.J.S., H. Schunkert.

Secondary analyses. Allele-specific FAIRE. Design of secondary analysis: A.J.P.S. Computation of secondary analysis: A.J.P.S., F.D., P.H. ASAP eQTL. Design of secondary analysis: A.F.-C. Computation of secondary analysis: L. Folkersen, P. Eriksson. CARDIOGENICS eQTL. Computation of secondary analysis: L. Lataniotis. Cardio-MetaboChip design. P.B.M., C.N.-C., T.J., B.F.V., H.M.K. Comprehensive literature review. Design of secondary analysis: P.B.M. Computation of secondary analysis: K.W., P.B.M. DEPICT. Design of secondary analysis: L. Franke, T.H.P., J.N.H. Computation of secondary analysis: T.H.P. DHS and methylation analysis by tissue. Design of secondary analysis: C.J.W. Computation of secondary analysis: E.M.S. DHS and methylation by cell line. Design of secondary analysis: D.I.C. Computation of secondary analysis: D.I.C., F. Giulianini. FHS eSNP. Design of secondary analysis: R. Joehanes. Computation of secondary analysis: R. Joehanes. ICBP SC. C.N.-C., M.J.C., P.B.M., A.C., K.M.R., P.F.O'R., W.P., D.L., M.D.T., B.M.P., A.D.J., P. Elliott, C.M.v.D., D.I.C., A.V. Smith, M. Bochud, L.V.W., H. Snieder, G.B.E. Kidney eQTL. Computation of secondary analysis: H.J.G., S.K.K. MAGENTA. Design of secondary analysis: D.I.C. Computation of secondary analysis: D.I.C. Miscellaneous. Computation of secondary analysis: H. Warren. MuTHER eQTL. Design of secondary analysis: P.D. Computation of secondary analysis: L. Lataniotis, T.-P.Y. NESDA eQTL. Design of secondary analysis: R. Jansen. Computation of secondary analysis: R. Jansen, A.V. NTR eQTL. Design of secondary analysis: R. Jansen. Computation of secondary analysis: R. Jansen, J.-J.H. Study PI: D.I.B. eQTL, EGCUT. Design of secondary analysis: A. Metspalu. Computation of secondary analysis: T.E., A. Metspalu. eQTL, Groningen. Design of secondary analysis: L. Franke. Computation of secondary analysis: H.-J.W., L. Franke. Public eSNP and methylation. Design of secondary analysis: A.D.J., J.D.E. Computation of secondary analysis: A.D.J., J.D.E. PubMed search. Design of secondary analysis: G.B.E. Computation of secondary analysis: G.B.E., L. Lin. WGHS conditional. Design of secondary analysis: D.I.C. Computation of secondary analysis: D.I.C., F. Giulianini, L.M.R.

Lookup of Cardio-MetaboChip variants. HEXA. Genotyping or analysis: Y.J.K., Y.K.K., Y.-A.S. Study PI: J.-Y.L. RACe. Study phenotyping: D. Saleheen, W. Zhao, A.R. Genotyping or analysis: W. Zhao, A.R. Study PI: D. Saleheen. HALST. Study phenotyping: C.A.H. Genotyping or analysis: J.I.R., Y.-D.C., C.A.H., R.-H.C., I.-S.C. Study PI: C.A.H. CLHNS. Study phenotyping: N.R.L., L.S.A. Genotyping or analysis: Y.W., N.R.L., L.S.A. Study PI: K.L.M., L.S.A. GxE/Spanish Town. Study phenotyping: B.O.T., C.A.M., R.W. Genotyping or analysis: C.D.P. Study PI: R.S.C., C.A.M., R.W., T. Forrester, J.N.H. DRAGON. Study phenotyping: W.-J.L., W.H.-H.S., K.-W.L., I.-T.L. Genotyping or analysis: J.I.R., Y.-D.C., E.K., D.A., K.D.T., X.G. Study PI: W.H.-H.S. SEY: study phenotyping: P.B. Genotyping or analysis: M. Bochud, G.B.E., F.M. Study PI: P.B., M. Bochud, M. Burnier, F.P. TUDR: study phenotyping: W.H.-H.S., I.-T.L., W.-J.L. Genotyping or analysis: J.I.R., Y.-D.C., E.K., K.D.T., X.G. Study PI: W.H.-H.S. TANDEM. Study phenotyping: P.B., M. Bochud. Genotyping or analysis: G.B.E., F.M. Study PI: P.B., M. Bochud, M. Burnier, F.P.

Imputed genotypes. FHS. Study phenotyping: D.L. Genotyping or analysis: D.L. Study PI: D.L. ARIC. Study phenotyping: E.B. Genotyping or analysis: G.B.E., E.B., A.C.M., A.C., S.K.G. Study PI: E.B., A.C. RS. Genotyping or analysis: G.C.V., A.G.U. Study PI: A. Hofman, A.G.U., O.H.F. CoLaus. Study phenotyping: P.V. Genotyping or analysis: Z.K. Study PI: P.V. NFBC1966. Study phenotyping: M.-R.J. Genotyping or analysis: P.F.O'R. Study PI: M.-R.J. SHIP. Study phenotyping: R. Rettig. Genotyping or analysis: A.T. CHS. Study phenotyping: B.M.P. Genotyping or analysis: K.M.R. Study PI: B.M.P. EPIC (GWAS). Study phenotyping: N.J.W., R.J.F.L., J. Luan. Genotyping or analysis: N.J.W., J.H.Z., J. Luan. Study PI: N.J.W., K.-T.K. SU.VI.MAX. Study phenotyping: S.H. Genotyping or analysis: S.H., P.M. Study PI: P.M. Amish. Genotyping or analysis: M.E.M. Study PI: A. Parsa. FENLAND (GWAS). Study phenotyping: N.J.W., J. Luan, R.J.F.L., K.K.O. Genotyping or analysis: N.J.W., J. Luan, R.J.F.L., K.K.O. Study PI: N.J.W. DGI. Study phenotyping: C.N.-C. Genotyping or analysis: C.N.-C., G. Kosova. Study PI: C.N.-C. ERF (EUROSPAN). Genotyping or analysis: N.A. Study PI: C.M.v.D. MIGEN. Study phenotyping: S. Kathiresan, R.E. Genotyping or analysis: S. Kathiresan, R.E. Design of secondary analysis: S. Kathiresan, R.E. MICROS. Study phenotyping: P.P.P. Genotyping or analysis: A.A.H. Study PI: A.A.H., P.P.P. FUSION. Genotyping or analysis: A.U.J. Study PI: M. Boehnke, F.S.C., K.L.M., J. Saramies. TwinsUK. Genotyping or analysis: C.M. Study PI: T.D.S. PROCARDIS. Genotyping or analysis: M. Farrall, A.G. Study PI: M. Farrall. BLSA. Study phenotyping: L. Ferrucci. Genotyping or analysis: T.T. Study PI: L. Ferrucci. ORCADES. Study phenotyping: J.F.W. Genotyping or analysis: R.M.F. Study PI: J.F.W. Croatia-Vis. Genotyping or analysis: V.V., C.H. Study PI: V.V., C.H. NSPHS. Genotyping or analysis: S. Enroth. Study PI: U.G. InCHIANTI. Genotyping or analysis: T.T. Study PI: S. Bandinelli. AGES Reykjavik. Study phenotyping: V.G. Genotyping or analysis: A.V. Smith. Study PI: V.G.

Lookup. CARDIoGRAMplusC4D. Genotyping or analysis: P.D. Study PI: J. Danesh, H. Schunkert, T.L.A., J.E., S. Kathiresan, R. Roberts, N.J.S., P.D., H. Watkins. CHARGE cIMT. Genotyping or analysis: C.J.O'D., J.C.B. CHARGE EYE. Genotyping or analysis: T.Y.W., X.S., R.A.J. Study PI: T.Y.W. CHARGE-HF Consortium. Study phenotyping: R.S.V., J.F.F. Genotyping or analysis: H.L., J.F.F. Study PI: R.S.V. CKDGen. Genotyping or analysis: M.G., V.M. COGENT-BP. Study phenotyping: N.F., J.R. Genotyping or analysis: N.F., X.Z., B.J.K., B.O.T., J.R. EchoGen Consortium. Study phenotyping: R.S.V., J.F.F. Genotyping or analysis: H.L., J.F.F. Study PI: R.S.V. KidneyGen Consortium. Study phenotyping: J.C.C., J.S.K., P. Elliott. Genotyping or analysis: W. Zhang, J.C.C., J.S.K. Study PI: J.C.C., J.S.K. MetaStroke. Genotyping or analysis: S. Bevan, H.S.M. NeuroCHARGE. Genotyping or analysis: M. Fornage, M.A.I. Study PI: M.A.I. PROMIS. Study phenotyping: D. Saleheen, W. Zhao, J. Danesh. Genotyping or analysis: W. Zhao. Study PI: D. Saleheen. SEED. Study phenotyping: T.Y.W., C.-Y.C. Genotyping or analysis: E.-S.T., C.-Y.C., C.-Y.C. Study PI: C.-Y.C., T.Y.W. UK Biobank. BP group leaders: M.J.C., P. Elliott. Genotyping or analysis: M.R.B., H. Warren, C.P.C., E.E., H.G.

Corresponding authors

Correspondence to Christopher Newton-Cheh or Patricia B Munroe.

Ethics declarations

Competing interests

I.B. owns stock in Incyte and GlaxoSmithKline. A.C. is a paid member of the Scientific Advisory Board of Biogen Idec. These potential conflicts of interest are managed by the policies of Johns Hopkins University School of Medicine. D.I.C. receives genotyping and collaborative scientific support from Amgen and receives support for genetic analysis from AstraZeneca. J.F.F. worked until 2013 in ErasmusAGE, a center for ageing research across the life course funded by Nestlé Nutrition (Nestec, Ltd), Metagenics, Inc., and AXA. H.J.G. currently works for Illumina. T.J. is an employee of and owns stock in GlaxoSmithKline. B.M.P. serves on the DSMB for a clinical trial funded by the manufacturer (Zoll LifeCor) and on the Steering Committee for the Yale Open Data Access Project funded by Johnson & Johnson. P.M.R. receives genotyping and collaborative scientific support from Amgen and receives support for genetic analysis from AstraZeneca. N.P. has received financial support from several pharmaceutical companies that manufacture blood pressure–lowering or lipid-lowering agents, or both, and consultancy fees. P.S. has received research awards from Pfizer. M.J.C. is Chief Scientist for Genomics England, a UK government company.

Additional information

A list of members and affiliations appears in the Supplementary Note.

A list of members and affiliations appears in the Supplementary Note.

A list of members and affiliations appears in the Supplementary Note.

Supplementary information

Supplementary Text and Figures

Supplementary Note and Supplementary Figures 1–10. (PDF 22466 kb)

Supplementary Table 1

Individual cohort study information and blood pressure measurement methods. (XLSX 22 kb)

Supplementary Table 2

Genotyping methods. (XLSX 23 kb)

Supplementary Table 3

Data type contribution and participant characteristics. (XLSX 26 kb)

Supplementary Table 4

Meta-analysis stage 4 results. (XLSX 12 kb)

Supplementary Table 5

UK-CardioMetabolic Consortium validation. (XLSX 12 kb)

Supplementary Table 6

Loci identified by GCTA with multiple signals of association. (XLSX 18 kb)

Supplementary Table 7

All SNPs selected by GCTA as independently associated with SBP. (XLSX 29 kb)

Supplementary Table 8

All SNPs selected by GCTA as independently associated with DBP. (XLSX 31 kb)

Supplementary Table 9

List of SNPs at genome-wide significant Cardio-MetaboChip loci for secondary analyses. (XLSX 17 kb)

Supplementary Table 10

Conditional analysis using the WGHS data set. (XLSX 29 kb)

Supplementary Table 11

Summary of Cardio-MetaboChip blood pressure fine-mapping regions. (XLSX 11 kb)

Supplementary Table 12

Ninety-nine percent credible intervals at Cardio-MetaboChip blood pressure fine-mapping regions. (XLSX 17 kb)

Supplementary Table 13

Ninety-nine percent credible causal SNPs at Cardio-MetaboChip blood pressure fine-mapping regions. (XLSX 59 kb)

Supplementary Table 14

eSNP analysis for cell types other than whole blood. (XLSX 15 kb)

Supplementary Table 15

eSNP analysis for whole blood. (XLSX 21 kb)

Supplementary Table 16

Analysis of enrichment of DNase-hypersensitive sites among the blood pressure loci, by cell type. (XLSX 59 kb)

Supplementary Table 17

Tissue categorization for DNase-hypersensitive site analyses. (XLSX 19 kb)

Supplementary Table 18

Analysis of enrichment of DNase-hypersensitive sites among the blood pressure loci, grouping cell types by tissue. (XLSX 13 kb)

Supplementary Table 19

Analysis of enrichment of methylation sites among the blood pressure loci. (XLSX 10 kb)

Supplementary Table 20

Blood pressure SNPs enriched in DHS sites in blood vessels. (XLSX 15 kb)

Supplementary Table 21

MAGENTA analysis. (XLSX 10 kb)

Supplementary Table 22

DEPICT analysis. (XLSX 9 kb)

Supplementary Table 23

FAIRE analysis. (XLSX 14 kb)

Supplementary Table 24

Non-European meta-analysis. (XLSX 74 kb)

Supplementary Table 25

Detailed results of risk score analyses for each SNP. (XLSX 72 kb)

Supplementary Table 26

Genetic blood pressure risk score analysis applied to related cardiovascular phenotypes. (XLSX 9 kb)

Supplementary Table 27

Genes at new blood pressure loci using DEPICT. (XLSX 11 kb)

Supplementary Data

Cardio-MetaboChip blood pressure association statistics (P values). Full results can be obtained via dbGaP. (CSV 8329 kb)

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Ehret, G., Ferreira, T., Chasman, D. et al. The genetics of blood pressure regulation and its target organs from association studies in 342,415 individuals. Nat Genet 48, 1171–1184 (2016). https://doi.org/10.1038/ng.3667

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