Hypertension Clinical Trial
To determine the genetic components of hypertension using a series of simulation experiments designed to determine the power and validity of the then recently developed methods of segregation and linkage analysis.
BACKGROUND:
There are two general hypotheses about the nature of the genetic component of hypertension.
A single gene hypothesis visualizes hypertension as a specific disease entity determined by
an autosomal dominant or incompletely dominant allele with little environmental effect. A
polygenic hypothesis views hypertension as determined by a large number of genetic and
environmental factors operating independently with roughly equal contributions. The evidence
supporting the single gene hypothesis is based primarily on bimodal and trimodal
distributions of blood pressure in the population. It has been suggested that the bimodal or
trimodal distributions are the result of ascertainment bias. The evidence supporting the
polygenic model is based on several studies where the distribution of blood pressure is
unimodal and often skewed toward higher values in both the population and in first degree
relatives of hypertensive individuals. These skewed distributions can be approximately
normalized using log transformations.
In this study, a particular effort was made to detect major genes. A major gene is said to
exist in a particular sample if an appreciable amount of the variability of a trait in that
sample is due to segregation of alleles at a single locus. The presence of a major gene does
not preclude the existence of other genetic or environmental effects. In the last decade
three general models have been proposed to detect the presence of a major gene. The
transmission probability model is a general model for the genetic analysis of pedigree data
which tests for Mendelian segregation ratios and is a generalization of the traditional
methods of segregation analysis. This model has little power to differentiate between single
gene and polygenic inheritance although it may be able to detect some kinds of non-single
gene transmission. This method has been extended to allow analysis of multivariate traits,
testing of a wide variety of hypotheses concerning modes of transmission and various
ascertainment corrections. Major genes identified with this model include
hypercholesterolemia, dopamine-beta-hydroxylase, and catechol-o-methytransferase.
The mixed model includes both a single locus and a multi-locus component and is designed to
distinguish between the two. The model assumes that all transmission from one generation to
the next that cannot be accounted for by classical polygenic inheritance is due to
segregation of alleles at a single locus. It is ideal for detecting a major gene in the
presence of polygenic inheritance provided that no other type of transmission is occurring.
This model has been extended to include an environmental correlation among sibs. Major loci
identified with this model include PTC, IgE and congenital glaucoma. The unified model is a
mixed model with the single locus component parameterized in terms of transmission
probabilities, and is a combination of the two previous models. Several research groups have
developed methodologies to overcome the computational difficulties presented by this
combined model.
DESIGN NARRATIVE:
The study was divided into two parts, the analysis of the methodologies and the application
of the methodologies in the genetic analysis of hypertension. In the first part of the
study, the power, robustness, and validity of three genetic models of segregation and
linkage analysis were considered: the transmission probability model; the mixed model; and
the unified model which was also a mixed model with the single locus component parameterized
in terms of transmission probabilities. The methods of segregation and linkage analysis
found to be most satisfactory were then applied to the analysis of data on five large
pedigrees in collaboration with Wright State University and to the analysis of ten large
pedigrees ascertained as part of the Bogalusa Heart Study. A determination was made of the
effects of partitioning large families into nuclear families and performing segregation and
linkage on these nuclear families.
The study completion date listed in this record was obtained from the "End Date" entered in
the Protocol Registration and Results System (PRS) record.
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