Genetic analysis of over one million people identifies 535 novel loci for blood pressure

High blood pressure is the foremost heritable global risk factor for cardiovascular disease. We report the largest genetic association study of blood pressure traits to date (systolic, diastolic, pulse pressure) in over one million people of European ancestry. We identify 535 novel blood pressure loci that not only offer new biological insights into blood pressure regulation but also reveal shared loci influencing lifestyle exposures. Our findings offer the potential for a precision medicine strategy for future cardiovascular disease prevention.

Christian Gieger | Gonçalo Abecasis | He Gao | Uwe Völker | Andres Metspalu | Todd L Edwards | Alexander Teumer | Borbala Mifsud | Markus Perola | Archie Campbell | Marina Evangelou | Christopher Oldmeadow | Johan Sundström | Rodney J Scott | Roby Joehanes | Eric Boerwinkle | Vilmundur Gudnason | Igor Rudan | Lars Lind | Tamara B Harris | Alice Stanton | Simon Thom | Katarzyna Witkowska | Paolo Gasparini | Andrew P Morris | Kenneth Rice | Walter Palmas | Anubha Mahajan | Evangelos Evangelou | Francis Collins | Marcus Dörr | Nilesh J Samani | Andrew D. Johnson | Morris A Swertz | Harry Campbell | Murielle Bochud | Reedik Mägi | Francesco Cucca | Nicholas J Wareham | Kelly Cho | Christophe Tzourio | Ioanna Tzoulaki | Christopher J O'Donnell | Nabi Shah | Ulf Gyllensten | Jie Yao | Maris Laan | Caroline Hayward | Michael Boehnke | Ruifang Li-Gao | Peter Almgren | Vilmantas Giedraitis | Philippe Amouyel | Sekar Kathiresan | Claudia Langenberg | Renée de Mutsert | Erik Ingelsson | Eleftheria Zeggini | Anuj Goel | Ibrahim Karaman | Samuli Ripatti | Albert Hofman | Praveen Surendran | John Danesh | Adam S Butterworth | Veikko Salomaa | Cornelia M van Duijn | Paul Elliott | Aravinda Chakravarti | Annette Peters | Xiuqing Guo | Daniel Levy | Ayush Giri | Edith Hofer | André G Uitterlinden | Roberto Elosua | Seppo Koskinen | Terho Lehtimäki | Jaume Marrugat | Massimo Mangino | Mika Kähönen | Tonu Esko | Nick Shrine | Chiara Batini | Louise V Wain | Martin D Tobin | Franco Giulianini | Martin Farrall | Dorret I Boomsma | Gonneke Willemsen | Lenore J Launer | Joshua C Bis | Ganesh Chauhan | Stella Trompet | J Wouter Jukema | Paul Knekt | Yan V Sun | Sandosh Padmanabhan | Yan V. Sun | Teresa Nutile | Marina Ciullo | Peter J Munson | Jouke-Jan Hottenga | Helena Schmidt | Sara M. Willems | Elin Org | Stefan Enroth | John R Attia | Heather J Cordell | Michael R Barnes | Andrew D Johnson | Lorna M. Lopez | Evan Tzanis | Oscar H Franco | Harriëtte Riese | John C Chambers | Jaakko Tuomilehto | Bernard D Keavney | Mattias Frånberg | Kay-Tee Khaw | Ozren Polasek | Antti-Pekka Sarin | Joris Deelen | Michela Traglia | Ahmad Vaez | Christopher P Nelson | Tim D Spector | Jennifer E Huffman | Alanna C Morrison | Lili Milani | Guillaume Paré | Bruce M. Psaty | Elizabeth G Holliday | Anne-Claire Vergnaud | Paul M Ridker | Anders Hamsten | Pim van der Harst | Georgios Ntritsos | Olli T Raitakari | Veronique Vitart | Ivana Kolcic | Ian J Deary | Yong Qian | Denis C Shields | Robert A Scott | Peter P Pramstaller | Jonathan Marten | Najaf Amin | Yuri Milaneschi | Daniela Toniolo | Bram Prins | Teemu Niiranen | Zoltan Kutalik | Yasaman Saba | Rossella Sorice | Peter Vollenweider | Jian'an Luan | Antonietta Robino | Alan F Wright | Philip S Tsao | Edward G Lakatta | Paul F O'Reilly | Ilaria Gandin | Marjo-Riitta Jarvelin | Niki Dimou | P. O’Reilly | P. Elliott | M. Jarvelin | J. Danesh | M. Nalls | C. Gieger | O. Franco | A. Hofman | A. Uitterlinden | P. Tsao | T. Spector | D. Levy | A. Peters | I. Deary | L. Wain | N. Shrine | R. Mägi | E. Zeggini | A. Morris | D. Strachan | M. Tobin | G. Abecasis | K. Kristiansson | T. Lehtimäki | E. Boerwinkle | V. Salomaa | M. Perola | C. Lindgren | M. Laakso | F. Collins | Z. Kutalik | M. Boehnke | P. Ridker | D. Chasman | N. Samani | P. Braund | M. Mangino | Morris J. Brown | J. Connell | P. Munroe | M. Caulfield | M. Farrall | T. Ferreira | V. Gudnason | D. Conen | Albert Vernon Smith | A. Chakravarti | P. Munson | P. Wilson | Stefan Enroth | O. Raitakari | E. Lakatta | Shih-Jen Hwang | A. James | Yongmei Liu | B. Psaty | D. Siscovick | A. Stanton | S. Wild | M. Barnes | B. Penninx | G. Willemsen | R. Scott | D. Arking | S. Ripatti | A. Metspalu | T. Esko | L. Milani | E. Ingelsson | A. Jackson | J. Tuomilehto | A. Morris | A. Doney | S. Kathiresan | P. Almgren | C. Newton-Cheh | K. Taylor | J. Rotter | L. Lind | L. Risch | I. Karaman | A. Havulinna | P. Jousilahti | T. Harris | I. Rudan | D. Boomsma | E. D. de Geus | M. Swertz | A. Gow | A. Pattie | J. Starr | H. Cordell | P. Amouyel | N. Wareham | K. Rice | Antti-Pekka Sarin | A. Mahajan | J. Hottenga | C. Nelson | J. Deelen | A. Hamsten | C. V. van Duijn | A. Jula | A. Hung | Xiuqing Guo | J. Jukema | C. O’Donnell | C. Tzourio | H. Schmidt | A. Teumer | U. Völker | S. Harris | A. Wright | R. Elosua | H. Watkins | R. Joehanes | J. Bis | J. Gaziano | Borbala Mifsud | B. Oostra | S. Koskinen | J. Kooner | E. Bottinger | J. Howson | A. Morgan | G. Davies | D. Liewald | L. Lopez | N. Amin | C. Hayward | P. Joshi | I. Kolčić | C. Oldmeadow | O. Polašek | V. Vitart | J. Attia | H. Campbell | F. Cucca | E. Holliday | M. Kähönen | L. Launer | P. Vollenweider | James F. Wilson | C. Hartman | J. Marten | R. Noordam | A. Campbell | A. Goel | J. Luan | I. Nolte | S. Padmanabhan | A. Robino | R. Scott | P. J. van der Most | H. Warren | Weihua Zhang | Jinghua Zhao | M. Brumat | R. de Mutsert | G. Ehret | E. Evangelou | I. Gandin | He Gao | C. Langenberg | B. Lehne | Y. Milaneschi | N. Poulter | L. Rose | Jie Yao | J. Chambers | P. Gasparini | A. Oldehinkel | P. van der Harst | D. Mook-Kanamori | W. Palmas | A. Morrison | Jun Ding | G. Verwoert | B. Keavney | R. Loos | R. Strawbridge | C. Palmer | K. Khaw | Å. Johansson | L. Lyytikäinen | A. Hicks | M. Bochud | U. Gyllensten | P. Pramstaller | I. Tzoulaki | A. Butterworth | J. Jukema | D. Shields | G. Paré | J. Marrugat | M. Dörr | R. Rettig | G. Chauhan | S. Debette | S. Trompet | V. Giedraitis | C. Menni | D. Stott | J. Sundström | N. Verweij | M. Cocca | T. Edwards | A. Giri | G. Girotto | R. Li-Gao | P. Surendran | P. Knekt | P. Sever | R. Jansen | E. Org | M. Laan | C. Kovesdy | T. Boutin | N. Dimou | R. Pazoki | B. Prins | E. Hofer | S. Thériault | A. Vergnaud | D. Toniolo | H. Riese | Kelly Cho | D. V. Velez Edwards | C. Batini | T. Zemunik | M. Traglia | J. Huffman | J. Hellwege | A. Hung | T. Nutile | M. D. de Borst | C. Cabrera | M. Sargurupremraj | N. Shah | Andrew A. Hicks | Mattias Frånberg | J. Knight | Yong Qian | C. Sala | C. Barbieri | F. Giulianini | T. Niiranen | M. Ciullo | R. Sorice | D. Vuckovic | Ahmad Vaez | Andrew P. Morris | P. Nandakumar | K. Ayers | S. Thom | Y. Saba | S. Sõber | Wei-Yu Lin | L. Lin | M. Evangelou | Christopher Newton-Cheh | Yongmei Liu | Niek Verweij | Ilja M Nolte | Jun Ding | Pekka Jousilahti | Alan J Gow | Cecilia M Lindgren | David Siscovick | Markku Laakso | Ben A Oostra | James F Wilson | Andrew A Hicks | Fu Liang Ng | Meixia Ren | Mark J Caulfield | David J Stott | Albert V Smith | Shih-Jen Hwang | Jerome I Rotter | John M Starr | Teresa Ferreira | Antti Jula | Aki S Havulinna | Sarah E Harris | M. Ren | Cumhur Yusuf Demirkale | Hugh Watkins | Gail Davies | Thibaud S. Boutin | Catharina A Hartman | Mike A Nalls | David P Strachan | Stéphanie Debette | Neil R Poulter | Rick Jansen | Leo-Pekka Lyytikäinen | Rainer Rettig | Anne U Jackson | Rona J Strawbridge | Sarah H Wild | Patricia B Munroe | Weihua Zhang | Jaspal S Kooner | Joanne Knight | Raymond Noordam | Lynda M Rose | Chrysovalanto Mamasoula | Muralidharan Sargurupremraj | Alison Pattie | Dan E Arking | Csaba P Kovesdy | A. Erzurumluoglu | Cristina Menni | Peter S Braund | C. Demirkale | Cinzia F Sala | Dennis O Mook-Kanamori | Kent D Taylor | Marty Larson | Brenda WJH Penninx | Peter Sever | Massimiliano Cocca | Fabiola M. Del Greco | Tatijana Zemunik | Siim Sõber | Helen R Warren | Claudia P Cabrera | John Connell | Georg B Ehret | Erwin P Bottinger | Kati Kristiansson | Andrew D Morris | David Conen | Sara M Willems | Peter WF Wilson | Ruth JF Loos | Morris J Brown | Albertine J Oldehinkel | Wei-Yu Lin | Adriana M Hung | Giorgia Girotto | K. Witkowska | T. Blake | Germaine C Verwoert | Lorna M Lopez | Lorenz Risch | David Mosen-Ansorena | Raha Pazoki | Thibaud Boutin | Sébastien Thériault | Tineka Blake | Marco Brumat | Alan James | Li Lin | Anna Morgan | Priyanka Nandakumar | Dragana Vuckovic | Peter J. van der Most | Digna R Velez Edwards | Peter J van der Most | Chrysovalanto Mamasoula | Jacklyn N Hellwege | F. Ng | Jing-Hua Zhao | Kristin L Ayers | Caterina M Barbieri | Martin H de Borst | Eco J de Geus | Peter K Joshi | Christopher J. O’Donnell | J.Michael Gaziano | Alex SF Doney | Fabiola M Del Greco | A.Mesut Erzurumluoglu | Åsa Johansson | Benjamin C Lehne | David CM Liewald | Lingchan Lu | Arno Palotie | Nguyen Quang Tri | Janina S Reid | Daniella Ruggiero | Rheinhold Schmidt | Harold Schneider | Dan Chasman | Joanna MM Howson | Ollie Melander | Colin NA Palmer | Lingchan Lu | D. Mosén-Ansorena | E. Tzanis | O. Melander | J. Attia | G. Ntritsos | P. Tsao | M. Larson | Åsa Johansson | A. Palotie | N. Quang Tri | D. Ruggiero | R. Schmidt | Harold Schneider | J. Yao | O. Raitakari | A. Johnson | R. Elosúa | James F. Wilson | Franco Giulianini | P. Wilson | Andrew D. Morris | P. van der harst | T. Spector | Borbála Mifsud | P. O’Reilly | D. Shields | Rodney J. Scott | A. Smith | Yan V. Sun | A. D. Morris | L. Rose | Weihua Zhang | M. Kähönen | A. Uitterlinden | Michela Traglia | T. Harris | A. Goel | A. Wright | A. Hofman | B. Oostra | C. V. van Duijn | D. Boomsma | B. Psaty | R. Loos | T. B. Harris | Ayush Giri | R. Scott | Janina S Reid | Christopher J. O'Donnell | C. Nelson | A. Wright | Michael A. Nalls | Andrew D. Johnson | MartinD. Tobin | Ruth J. F. Loos | Jerome I. Rotter | Alan F. Wright | John M. Starr | B.W.J.H. Penninx | B. D. Keavney | Robert A. Scott | Olli T. Raitakari | A. Peters | Albert V Smith | Oscar H. Franco | A. Jackson | Morris J. Brown | Sarah H. Wild | George B. Ehret | Paul F. O’Reilly | Yan V. Sun | N. Wareham | N. Poulter | B. Keavney | Adriana M. Hung | D. Levy | Elizabeth G. Holliday | Rodney J. Scott | A. Campbell | Colin N. Palmer | Cecilia M. Lindgren | D. Stott | A. Uitterlinden | Cornelia M. van Duijn | Sarah E. Harris | Andrew P. Morris | Andrew D. Morris | Todd L. Edwards | Adriana M Hung | Denis C. Shields | F. L. Ng | Claudia P. Cabrera | C. Newton‐Cheh | B. Psaty | Kent D. Taylor | Albert V. Smith | Erwin P. Bottinger | G. Davies | Kristin L. Ayers | Michael R. Barnes | Peter J. Munson | Alex S. F. Doney | Nilesh J. Samani | David P. Strachan | A. Doney | C. A. Hartman | Nabi Shah | Peter Wf Wilson | Heather J Cordell | Janina S Reid | Christopher J. O'Donnell | A. Peters | Michael R Barnes | Sarah H Wild | C. Hartman | B. Penninx | Neil R. Poulter | J. Starr | Christopher J. O’Donnell | Georgios Ntritsos | L. Lin | Rodney J Scott | P. W. Wilson | Ruifang Li-Gao

[1]  Y. Fukumoto,et al.  Elevated Plasma Transforming Growth Factor &bgr;1 Levels Predict the Development of Hypertension in Normotensives: The 14-Year Follow-Up Study , 2017, American journal of hypertension.

[2]  Ayellet V. Segrè,et al.  Twelve type 2 diabetes susceptibility loci identified through large-scale association analysis , 2010, Nature Genetics.

[3]  Marcelo P. Segura-Lepe,et al.  Rare and low-frequency coding variants alter human adult height , 2016, Nature.

[4]  E. Lalli,et al.  The Wnt/beta-catenin pathway in adrenocortical development and cancer , 2011, Molecular and Cellular Endocrinology.

[5]  J. Ioannidis,et al.  Meta-analysis methods for genome-wide association studies and beyond , 2013, Nature Reviews Genetics.

[6]  Evangelos Evangelou,et al.  Heterogeneity in Meta-Analyses of Genome-Wide Association Investigations , 2007, PloS one.

[7]  Morris J. Brown,et al.  Pregnancy, Primary Aldosteronism, and Adrenal CTNNB1 Mutations. , 2015, The New England journal of medicine.

[8]  Ashutosh Kumar Singh,et al.  Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 , 2016, Lancet.

[9]  N. Risch,et al.  Genome-wide association analyses using electronic health records identify new loci influencing blood pressure variation , 2016, Nature Genetics.

[10]  He Gao,et al.  Genome-wide association analysis identifies novel blood pressure loci and offers biological insights into cardiovascular risk , 2017, Nature Genetics.

[11]  J. Hirschhorn,et al.  Biological interpretation of genome-wide association studies using predicted gene functions , 2015, Nature Communications.

[12]  L. Powell-Braxton,et al.  Hypertension and endothelial dysfunction in apolipoprotein E knockout mice. , 1999, Arteriosclerosis, thrombosis, and vascular biology.

[13]  R. Trembath,et al.  Heterozygous germline mutations in BMPR2, encoding a TGF-β receptor, cause familial primary pulmonary hypertension , 2000, Nature Genetics.

[14]  L. Dell’Italia,et al.  Novel Paradigms of Salt and Hypertension. , 2017, Journal of the American Society of Nephrology : JASN.

[15]  E. Porteri,et al.  A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. , 2006, Journal of the American College of Cardiology.

[16]  M. Caulfield,et al.  Genes for blood pressure: an opportunity to understand hypertension. , 2013, European heart journal.

[17]  Nuala A Sheehan,et al.  Adjusting for treatment effects in studies of quantitative traits: antihypertensive therapy and systolic blood pressure , 2005, Statistics in medicine.

[18]  Ricardo Pong-Wong,et al.  Evaluating the contribution of genetic and familial shared environment to common disease using the UK Biobank , 2016, Nature Genetics.

[19]  M. Woodward,et al.  Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data , 2014, The Lancet.

[20]  D. Calhoun,et al.  Hyperaldosteronism Among Black and White Subjects With Resistant Hypertension , 2002, Hypertension.

[21]  Anthony D. Schmitt,et al.  A Compendium of Chromatin Contact Maps Reveals Spatially Active Regions in the Human Genome. , 2016, Cell reports.

[22]  R. Mägi,et al.  Cohort Profile Cohort Profile : Estonian Biobank of the Estonian Genome Center , University of Tartu , 2015 .

[23]  Jing Wang,et al.  WebGestalt 2017: a more comprehensive, powerful, flexible and interactive gene set enrichment analysis toolkit , 2017, Nucleic Acids Res..

[24]  Gabor T. Marth,et al.  A global reference for human genetic variation , 2015, Nature.

[25]  Katsuya Tanaka,et al.  Phosphatidylinositol 3‐kinase inhibition induces vasodilator effect of sevoflurane via reduction of Rho kinase activity , 2017, Life sciences.

[26]  Núria Queralt-Rosinach,et al.  DisGeNET: a discovery platform for the dynamical exploration of human diseases and their genes , 2015, Database J. Biol. Databases Curation.

[27]  J. Tanus-Santos,et al.  Polymorphisms in VEGFA gene affect the antihypertensive responses to enalapril , 2015, European Journal of Clinical Pharmacology.

[28]  Christian Gieger,et al.  Genetic Variants in Novel Pathways Influence Blood Pressure and Cardiovascular Disease Risk , 2011, Nature.

[29]  J. Rothstein,et al.  Signal-Crosstalk Between Rho/ROCK and c-Jun NH2-Terminal Kinase Mediates Migration of Vascular Smooth Muscle Cells Stimulated by Angiotensin II , 2005, Arteriosclerosis, thrombosis, and vascular biology.

[30]  Ewan Birney,et al.  FORGE: A tool to discover cell specific enrichments of GWAS associated SNPs in regulatory regions , 2014, bioRxiv.

[31]  Christian Gieger,et al.  Genome-wide association study identifies six new loci influencing pulse pressure and mean arterial pressure , 2011, Nature Genetics.

[32]  P. Munroe,et al.  Exploring hypertension genome‐wide association studies findings and impact on pathophysiology, pathways, and pharmacogenetics , 2015, Wiley interdisciplinary reviews. Systems biology and medicine.

[33]  Núria Queralt-Rosinach,et al.  DisGeNET: a comprehensive platform integrating information on human disease-associated genes and variants , 2016, Nucleic Acids Res..

[34]  Yun Li,et al.  METAL: fast and efficient meta-analysis of genomewide association scans , 2010, Bioinform..

[35]  P. Donnelly,et al.  Genome-wide genetic data on ~500,000 UK Biobank participants , 2017, bioRxiv.

[36]  M. Daly,et al.  LD Score regression distinguishes confounding from polygenicity in genome-wide association studies , 2014, Nature Genetics.

[37]  C. Sing,et al.  The influence of genetics and household environment upon the variability of normal blood pressure: the Montreal Adoption Survey. , 1986, Clinical and experimental hypertension. Part A, Theory and practice.

[38]  He Zhang,et al.  Trans-ancestry meta-analyses identify rare and common variants associated with blood pressure and hypertension , 2016, Nature Genetics.

[39]  Claude Bouchard,et al.  Meta-analysis identifies common and rare variants influencing blood pressure and overlapping with metabolic trait loci , 2016, Nature Genetics.

[40]  P. Elliott,et al.  UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age , 2015, PLoS medicine.

[41]  Jacqueline P Mitchell,et al.  Circulating Apolipoprotein E Concentration and Cardiovascular Disease Risk: Meta-analysis of Results from Three Studies , 2016, PLoS medicine.

[42]  K. Rawlik,et al.  An atlas of genetic associations in UK Biobank , 2017, Nature Genetics.

[43]  Stephen Burgess,et al.  PhenoScanner: a database of human genotype–phenotype associations , 2016, Bioinform..

[44]  K. Conrad Unveiling the vasodilatory actions and mechanisms of relaxin. , 2010, Hypertension.

[45]  P. Val,et al.  Adrenal cortex tissue homeostasis and zonation: A WNT perspective , 2015, Molecular and Cellular Endocrinology.

[46]  Andrew D. Johnson,et al.  Novel Blood Pressure Locus and Gene Discovery Using Genome-Wide Association Study and Expression Data Sets From Blood and the Kidney , 2017, Hypertension.

[47]  Ivy Shiue,et al.  Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015 , 2017, JAMA.

[48]  Bonnie Berger,et al.  Efficient Bayesian mixed model analysis increases association power in large cohorts , 2014 .

[49]  Mary Brophy,et al.  Million Veteran Program: A mega-biobank to study genetic influences on health and disease. , 2016, Journal of clinical epidemiology.

[50]  L. Wain,et al.  Novel insights into the genetics of smoking behaviour, lung function, and chronic obstructive pulmonary disease (UK BiLEVE): a genetic association study in UK Biobank , 2015, The Lancet. Respiratory medicine.

[51]  Manuel A. R. Ferreira,et al.  PLINK: a tool set for whole-genome association and population-based linkage analyses. , 2007, American journal of human genetics.

[52]  Alan M. Kwong,et al.  A reference panel of 64,976 haplotypes for genotype imputation , 2015, Nature Genetics.

[53]  O. Troyanskaya,et al.  Predicting effects of noncoding variants with deep learning–based sequence model , 2015, Nature Methods.

[54]  Xiaofeng Zhu,et al.  The genetics of blood pressure regulation and its target organs from association studies in 342,415 individuals , 2016, Nature Genetics.

[55]  J. Bertherat,et al.  Mutations of beta-catenin in adrenocortical tumors: activation of the Wnt signaling pathway is a frequent event in both benign and malignant adrenocortical tumors. , 2005, Cancer research.

[56]  J C Christian,et al.  The NHLBI twin study of cardiovascular disease risk factors: methodology and summary of results. , 1977, American journal of epidemiology.

[57]  Neva C. Durand,et al.  A 3D Map of the Human Genome at Kilobase Resolution Reveals Principles of Chromatin Looping , 2014, Cell.

[58]  P. D. Bakker,et al.  Resetting the bar: Statistical significance in whole‐genome sequencing‐based association studies of global populations , 2017, Genetic epidemiology.

[59]  Jeanette Spear,et al.  The Airwave Health Monitoring Study of police officers and staff in Great Britain: rationale, design and methods. , 2014, Environmental research.

[60]  Hai-Jian Sun,et al.  Relaxin in paraventricular nucleus contributes to sympathetic overdrive and hypertension via PI3K-Akt pathway , 2016, Neuropharmacology.

[61]  K. Caron,et al.  Cardiovascular effects of exogenous adrenomedullin and CGRP in Ramp and Calcrl deficient mice , 2017, Peptides.