1. Introduction
Blood pressure (BP) is a quantitative trait that is affected by both multifactorial genetic and environmental factors [
1,
2,
3]. The heritability of high blood pressure is estimated to be 30-50% [
4]. Elevated blood pressure otherwise called hypertension is the leading risk factor for many cardiovascular diseases like stroke and coronary artery diseases [
5,
6]. The global prevalence of hypertension among adults aged 30-79 years increased significantly from 650 million in 1990 to 1.28 billion in 2019; with two-thirds of this burden coming from low-income countries (LMICs) [
7]. When compared to other ethnic groups, African Americans and other African ancestry show a higher occurrence of high blood pressure [
8,
9,
10,
11].
Despite the global rise in the disease burden among individuals of African ancestry, limited genome-wide association studies (GWASs) of blood pressure traits have been conducted or included individuals of African ancestry [
12,
13]. For instance, the largest GWAS of blood pressure conducted to date in approximately a million individuals was predominantly consist of Europeans [
15]. Additionally, only ~62% of all the genome-wide significant loci from this GWAS had the concordant direction of effects for individuals of African ancestry and moderate Pearson correlation coefficients with effect estimates in Europeans r2=0.37 in Africans, compared to the strong r2=0.78 for South Asians [
15,
16,
17,
18]. Another example is that majority of blood pressure GWASs conducted in African ancestry populations have small sample sizes [
19,
20,
21,
22,
23] and they mostly use single trait approach without giving due consideration to the phenotypic relatedness and the relationship between the two traits (SBP and DBP), which is a possible link between risk-related clinical measures and arterial properties [
24,
25]. Thus, many novel insights into blood pressure traits in people of African ancestry remain to be discovered.
Furthermore, various GWAS reports have shown that the genetic determinants of blood pressure have small effect sizes and vary significantly between European and non-European populations [
26]. Therefore, our study aim to extensively study the African population to better understand the genetic epidemiology underlying blood pressure traits in individuals of African descent. We also perform a multivariate GWAS in the hope that it will increase our study’s statistical power over the univariate approach and consequently increase the overall number of novel loci observed in our study.
We conducted the largest GWAS of blood pressure in over 77,850 people from the African Partnership for Chronic Disease and Research (APCDR), African ancestry people from the United Kingdom (UK-Biobank), and the Million Veteran Program in this study (MVP).
Figure 1 depicts the overall study design; we used fixed effects meta-analysis across the cohorts. We then performed a multivariate analysis, fine-mapping, pathway and tissue enrichment test analysis, and pathway and tissue enrichment test analysis to highlight relevant biological processes and investigate causal relationships with disease traits.
4. Discussion
This study describes the largest GWAS of blood pressure in African ancestry to date, involving a total of 77,850 individuals from the MVP, APCDR, and UK Biobank cohorts. The results of this analysis provide additional relevant information on the genetic and biological architecture of blood pressure traits in people of African ancestry.
According to our results, the multivariate GWAS approach had greater statistical power in identifying new variants than the univariate meta-analysis (
Figure 6). Previous GWAS studies had shown the power of the multivariate approach, especially when dealing with traits that are highly correlated [
27].
Five novel variants were discovered using both methods. The multivariate approach identified three variants:
DNAJC17P1/GLULP6 (rs138493856),
RRM2 (rs139235642), and
LOC105377644 (rs72619992), while the univariate approach identified two variants:
AC074290.1 (rs77534700) and
MOBP (rs562545). The
DNAJC17P1/GLULP6 gene, which is located in the intergenic region, is known to be associated with susceptibility to infectious disease measurement [
28] as well as educational attainment [
29]. The
RRM2 is a protein-coding gene that encodes one of two non-identical subunits for ribonucleotide reductase and is highly expressed in the bone marrow (28.1) and lymph node (20.5), along with other tissues [
30]. The high expression of this gene can lead to the abnormal proliferation of histiocytes and can also be used as a marker for malignant changes in ovarian endometriosis [
31]. The rs72619992 variant in
LOC105377644 is an uncharacterized RNA gene that belongs to the ncRNA class and does not code for any protein. In
AC074290.1, our univariate method identified an uncharacterized pseudogene. According to the GWAS catalog, the
MOBP gene, which is a myelin-associated oligodendrocyte-associated protein, is linked to Alzheimer’s disease [
32], cognitive performance, and other brain-related disorders [
33]. The
MOBP gene is thought to be involved in both frontotemporal dementia and nervous system development. We used the largest BP summary statistics from European ancestry individuals to look up our lead SNPs, while some of the lead SNPs were found to be replicated at replicated at
P-value 0.05. None of the SNPs identified as being novel replicated (
Supplementary 13).
In the meta-analysis results, our in silico functional mapping and annotation analyses from FUMA revealed several biologically relevant signals. SBP gene sets, for example, were significantly associated with associated biological systems such as several synapse assembly components (such as components correlated to nervous system development/neurons and chemical or electrical synapses), candidate genes in regions of copy number loss in gastric cancer cell lines, cell-cell adhesion via plasma membrane adhesion molecules (possibly, part of action potentials generated by the movement of ions through transmembranous channels), and cell-cell adhesion via plasma membrane adhesion.
In addition, the SBP meta-analysis tissue enrichment analysis was associated with significantly up-regulated DEGs in the sigmoid and transverse colon (
Supplementary Figure 1); which may suggest that gut microbiota may play a role in the regulation of gastro-renal axis and blood pressure [
34]. Furthermore, the most interesting enrichment of input genes in gene sets significant in the Reactome was in the cardiac conduction and muscle contraction pathways for the SBP meta-analysis, which are the mechanisms and pathways that elicit rapid changes in the heart rate, blood pressure, and respond to changes in autonomic tone. On the other hand, our DBP MAGMA tissue expression analysis highlighted nine brain tissue types associated with DBP. For instance, the putamen, caudate, and nucleus accumbens basal ganglia are input nuclei as well as part of the corpus striatum, and the substantia nigra is a basal ganglia function-related nuclei, which are all involved in processing movement-related information. Dysfunction in this region is known to be associated with movement disorders like Huntington’s, as correlated by GWAS catalog genes highlighted. In addition, the GWAS catalog genes included in gene sets included blood pressure traits and their interactions with alcohol and cigarette smoking, hence, these may be interesting environmental risk factors that should be investigated for their impact on BP traits in populations of African descent. Further investigation is needed to understand this, as different regions have different drinking and smoking habits.
Furthermore, our tissue expression analysis shows that DBP gene expression is enriched in the brain hippocampus (
Figure 3), a brain region that is essential for learning and memory [
35]. According to one study, hypertension is linked to decreased functional hippocampus connectivity and impaired memory [
36]. As a result, more research is needed to understand our findings from
in silico functional mapping and annotation analyses, as well as their mechanism.
Our current study has several strengths. First, our study is the largest SBP and DBP GWAS meta-analysis of an African population; thus, it has allowed us to find novel loci and replicate prior findings. Secondly, our functional mapping and annotation found several biologically relevant regions, that support our genetic findings, and these regions, tissues, and pathways are good candidates to explore further to elucidate the pathogenesis of blood pressure-related disorders like hypertension and prevent or treat them better. Finally, fine-mapping recommended target candidate loci to test in vivo and in vitro to improve our understanding of the regulators and genetic factors that affect blood pressure traits. The CPASSOC used for our multivariate GWAS increased statistical power and reflected the nature of the multivariate effect of traits on the genetic factor.
One of our limitations is that the "black" participants in our study are primarily from admixed regions with a variety of characteristics. Thus, our study used a small sample size from the continental African population, and this may be the reason why most of our variants were identified from the MVP dataset, as this data had the largest sample size (
Table 3). Although our study is the largest study of SBP and DBP genetics, the overall sample size was small compared to contemporary GWASs for other traits. Thus, future studies will need to include more continental Africans to make sure our genetic risk factors can be used to make genetic risk scores that are inclusive of all or most African populations and their full range of diversity. Due to the diversity in African genome, latent sub-structuring could inflate the results, but this effect was minimized by adjusting for principal components in the GWAS model by the contributing cohorts. Second, the paucity of functional genomics information specific to African people makes it challenging to evaluate the functional relevance of the relationships found. Thirdly, regional environmental factors, including dietary variations, variances in the prevalence of TB and HIV, and other non-communicable disease factors, could potentially have an impact on BP outcomes; however, there isn’t enough research on these aspects in our target group. Afrocentric GWAS data are grossly limited, hence we used Blood pressure GWAS data from individual of African ancestry available and accessible to the authors.
In conclusion, we have conducted the largest GWAS of blood pressure in African ancestry, which has significantly enabled an in-depth understanding of the genetic component. Our analysis emphasizes the relevance of applying fine-mapping and multivariate methods to correlated trait and their increase in statistical power toward the discovery of causal variants. These strategies offer a reliable approach to better understanding the genetic epidemiology of blood pressure disease in African ancestry and treatment development strategy. Lastly, to better understand the implication of these results, future studies could replicate the result on the European population.