Hypertension Clinical Trial
To seek out genes or genetic markers which identify subjects more vulnerable to hypertension under the influence of environmental factors.
BACKGROUND:
Essential hypertension is a multifactorial disorder with a Gaussian distribution and with a
genetic component that appears to be polygenic and heterogeneous. The studies require
clinical knowledge of the pathophysiology and therapy of hypertension, availability of a
large racially diverse patient population and a General Clinical Research Center for
recruitment, characterization and classification of subjects, in combination with knowledge
of molecular biology for DNA preparation and expertise in molecular genetics and molecular
epidemiology for genetic analysis.
The study is part of a Specialized Centers of Research initiative in the Molecular Genetics
of Hypertension. The initiative originated in deliberations of the September 1992 National
Heart, Lung, and Blood Advisory Council. In May 1993, a program evaluation committee
convened by the NHLBI was charged with the task of assessing the overall goals of the
Hypertension SCOR program and of recommending areas of future need. The committee's
recommendations formed the basis of this proposed initiative which was released as a Request
for Applications in December, 1993.
DESIGN NARRATIVE:
The study, a subproject within a Hypertension Specialized Center of Research (SCOR), had
five substudies between 1996 and 2001. The first classified hypertensives into relatively
homogeneous subgroups according to intermediate phenotypes based on heritable biological
traits, including anthropometric and neurohumoral data obtained by submitting selected
subjects to a 3-day inpatient protocol, from which data were extrapolated and applied to
stratify larger subject populations in order to enhance efficacy of subsequent genetic
analysis. The second substudy genotyped subjects for chromosomal loci using approximately
350 highly polymorphic microsatellite markers spaced every 5-10 centimorgans (cM) along each
chromosome. The strategy was to initially type markers in a select group of hypertensive
kindreds that independently demonstrated linkage. The third substudy analyzed the genetic
marker data for linkage using both parametric (lod score) and nonparametric
(affected-pedigree-member) methods. Suggestive findings were pursued in the sib-pairs. The
fourth substudy used the case-control method to confirm positive linkage from substudy 3 and
to identify particular allele associations using methods of linkage disequilibrium and DNA
pooling. The fifth substudy screened and assessed mutations in candidate genes linked to
hypertension in patients and controls. A collaboration was established with the Framingham
Heart Study, with linkage analyses conducted for hypertension in this cohort.
The subproject was renewed in February 2001 through 2006 to continue the clinical studies
and to expand the collection of hypertensive families, including subjects who have undergone
extensive clinical evaluation and who can be subgrouped into intermediate phenotypes, as
well as families from genetically isolated populations from Greece, Israel, and South
Africa. Various subsets of this population will be submitted to different genetic analyses
as appropriate, including linkage and association studies, genome-wide scan for genetic
isolates, evaluation of single nucleotide polymorphisms in selected genes, testing of
quantitative trait loci (QTL) by micro satellite markers and mapping of promising marrow
regions by DNA sequencing.
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