title: Phenotypic consequences of variation across the aldosterone synthase and 11-beta hydroxylase locus in a hypertensive cohort: data from the MRC BRIGHT Study.
abstract: BACKGROUND
  Aldosterone is an important cardiovascular hormone; 15% of hypertensive subjects have alteration in aldosterone regulation, defined by a raised ratio of aldosterone to renin (ARR). Studies of the aldosterone synthase gene (CYP11B2) have focused on a single nucleotide polymorphism in the 5'promoter region (-344 C/T). In normotensive subjects, the T allele associates with raised levels of the 11-deoxysteroids, deoxycorticosterone and 11-deoxycortisol which are substrates for 11beta-hydroxylase, encoded by the adjacent and homologous gene, CYP11B1. We have speculated that this altered 11beta-hydroxylase efficiency leads to increased ACTH drive to the adrenal gland to maintain cortisol production and reported herein the association between the -344 C/T single nucleotide polymorphism (SNP) and adrenal steroid production in subjects with essential hypertension.
  
  
  METHODS
  The CYP11B2-344 C/T polymorphism was genotyped and urinary excretion of adrenal steroid metabolites was measured (by GCMS) in 511 unrelated hypertensives from the Medical Research Council (MRC) British Genetics of Hypertension (BRIGHT) study.
  
  
  RESULTS
  Thirty-five per cent of subjects were homozygous for the -344T allele whilst 16% were CC homozygotes. There was no difference in cortisol excretion rate between the two genotype groups but the index of adrenal 11beta-hydroxylation (ratio of tetrahydrodeoxycortisol/total cortisol) was significantly higher in the TT group (P < 0.005) than in the CC group. Excretion rates of the major urinary metabolite of aldosterone (tetrahydroaldosterone) correlated strongly with the ACTH-regulated steroids, cortisol (r = 0.437, P < 0.0001) and total androgen metabolites (r = 0.4, P < 0.0001) in TT but not CC subjects.
  
  
  CONCLUSIONS
  Hypertensives homozygous for the -344 T allele of CYP11B2 demonstrate altered 11beta-hydroxylase efficiency (CYP11B1); this is consistent with the hypothesis of a genetically determined increase in adrenal ACTH drive in these subjects. The correlation between excretion of aldosterone and cortisol metabolites and suggests that, in TT subjects, ACTH exerts an important common regulatory influence on adrenal corticosteroid production in subjects with hypertension.
authors.affiliation: Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, UK. emf12k@clinmed.gla.ac.uk
authors.forename: E M
authors.initials: EM
authors.lastname: Freel
authors.forename: M
authors.initials: M
authors.lastname: Ingram
authors.forename: E C
authors.initials: EC
authors.lastname: Friel
authors.forename: R
authors.initials: R
authors.lastname: Fraser
authors.forename: M
authors.initials: M
authors.lastname: Brown
authors.forename: N J
authors.initials: NJ
authors.lastname: Samani
authors.forename: M
authors.initials: M
authors.lastname: Caulfield
authors.forename: P
authors.initials: P
authors.lastname: Munroe
authors.forename: M
authors.initials: M
authors.lastname: Farrall
authors.forename: J
authors.initials: J
authors.lastname: Webster
authors.forename: D
authors.initials: D
authors.lastname: Clayton
authors.forename: A F
authors.initials: AF
authors.lastname: Dominiczak
authors.forename: E
authors.initials: E
authors.lastname: Davies
authors.forename: J M C
authors.initials: JM
authors.lastname: Connell
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000483:Alleles; D003350:Cortodoxone / Q000097:blood; D019405:Cytochrome P-450 CYP11B2 / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D013252:Steroid 11-beta-Hydroxylase / Q000235:genetics*
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D019405:Cytochrome P-450 CYP11B2; D013252:Steroid 11-beta-Hydroxylase; D003350:Cortodoxone