title: Familial aggregation of low-renin hypertension.
abstract: Low-renin hypertension, representing roughly one quarter of all essential hypertension, is widely recognized by distinct physiological features, including salt-sensitivity, diuretic- responsiveness, and a favorable natural history. Although certain demographic features including age, ethnicity, and diabetes mellitus predispose to low-renin hypertension, these factors account for only a minority of cases. We examined familial concordance for renin status in 119 families with 257 hypertensive members. Low-renin was defined rigorously by plasma renin activity < or =0.69 ng angiotensin I/L per second, drawn when subjects had achieved balance after 5 to 7 days on a 10 mmol sodium diet and had stood upright for at least 1 hour. Given the prevalence of low-renin hypertension in our general population, low-renin hypertension was significantly more concordant among siblings than expected by chance (P=0.01). There were twice as many low-renin families as expected (10.9% versus 5.5%), in sharp contrast to the normal-renin state, in which the observed and expected were similar (61.0% versus 58.6%). These results were independent of age, race, and gender. Variance in renin status attributable to family membership was 35%. Association studies were performed on 8 polymorphisms in 5 candidate genes, and significant association was confirmed with the G460W polymorphism of the adducin gene. Familial determinants, which are probably but not definitely genetic, contribute to the low-renin hypertension state.
authors.affiliation: Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass 02115, USA. nfisher@partners.org
authors.forename: Naomi D L
authors.initials: ND
authors.lastname: Fisher
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.forename: Xavier
authors.initials: X
authors.lastname: Jeunemaitre
authors.forename: Paul N
authors.initials: PN
authors.lastname: Hopkins
authors.forename: Norman K
authors.initials: NK
authors.lastname: Hollenberg
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Williams
mesh_terms: D000328:Adult; D005192:Family Health; D005260:Female; D005838:Genotype; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D012083:Renin / Q000097:blood*
chemical_list: D012083:Renin