Association analyses of predicted loss-of-function variants prioritized 15 genes as blood pressure regulators

Background: Hypertension, clinically defined by elevated blood pressure (BP), is an important cause of mortality and morbidity worldwide. Many risk factors for hypertension are known, including a positive family history, which suggests that genetics contribute to inter-individual BP variation. Genome-wide association studies (GWAS) have identified >1000 loci associated with BP, yet the identity of the genes responsible for these associations remains largely unknown. Methods: To pinpoint genes that causally impact BP variation in humans, we analyzed predicted loss-of-function (pLoF) variants in the UK Biobank whole-exome sequencing dataset (n=454,709 participants, 6% non-European ancestry). We analyzed genetic associations between systolic or diastolic BP (SBP/DBP) and single pLoF variants (additive and recessive genetic models) as well as with the burden of very rare pLoF variants (minor allele frequency [MAF] <0.01%). Results: Single pLoF variants in ten genes associated with BP (ANKDD1B, ENPEP, PNCK, BTN3A2, C1orf145 [OBSCN-AS1], CASP9, DBH, KIAA1161 [MYORG], OR4X1, and TMC3). We also found a burden of rare pLoF variants in five additional genes associated with BP (TTN, NOS3, FES, SMAD6, COL21A1). Except for PNCK, which is located on the X-chromosome, these genes map near variants previously associated with BP by GWAS, validating the study of pLoF variants to prioritize causal genes at GWAS loci. Conclusions: Our study highlights 15 genes that likely modulate BP in humans, including five genes that harbor pLoF variants associated with lower BP.