H ypertension is a common condition that according to a global study will affect 1.56 billion adults by the year 2025.1 Despite this, essential hypertension (EH) remains as a complex phenotype in which genetic determinants remain largely undefined. 2,3 A recent large study of Sardinian families estimated a broad-sense heritability of ≈65% and ≈45% for systolic and diastolic blood pressure (BP), respectively. 4 In general, large-scale epidemiological studies suggest that the heritability of BP exceeds 50%, justifying a search for genetic variants influencing susceptibility to EH. 5,6 Indeed, the human genome contains several genetic variants that may influence the BP and have been associated with hypertension. 7,8 In this regard, the AGTRAP-MTHFR-CLCN6-NPPA-NPPB gene cluster at 1p36 has been associated with cardiac dysfunction, BP, and renal disease.2,9-11 MTHFR is a key element within this gene cluster that codifies for the enzyme methylenetetrahydrofolate reductase, which catalyzes the reduction of 5,10-methylenetetrahydrofolate to 5 methyltetrahydrofolate, a cosubstrate Background-Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) have been associated with diastolic blood pressure, hypertension, and other cardiovascular diseases; however, results of these studies are still controversial. In this study, we sought to determine whether 2 functional variants (rs1801133 and rs13306560) within the MTHFR are associated with hypertension in Mexican-Mestizos. Methods and Results-We performed a case-control study with 1214 subjects including adults and children to test for the association of both single nucleotide polymorphisms with essential hypertension. The adult group included 764 participants (372 patients and 391 controls) and the group of children included 418 participants (209 patients and 209 controls). rs13306560 was associated with essential hypertension in adults (odds ratio, 4.281; 95% confidence interval, 1.841-9.955; P=0.0003) with a statistical power >0.8. In children, none of the polymorphisms was associated with essential hypertension. In addition, we assessed the effect of the rs13306560 polymorphism on the MTHFR promoter region by means of luciferase reporter gene assays using human umbilical vein endothelial cells. Cells transfected with the pMTHFRaLUC construct showed an ≈25% reduction in luciferase activity (P=0.003). Furthermore, the promoter activity was reduced considerably by in vitro methylation of CpG sequences. Conclusions-Our data suggest that the rs13306560 polymorphism of the MTHFR may be part of the observed hypertension process in Mexican-Mestizo populations, but further studies are warranted. In addition, the allele A of the rs13306560 polymorphism as well as the in vitro methylation of CpGs reduced the promoter activity of the MTHFR regulatory region. for homocysteine remethylation to methionine. 12 The T allele of the rs1801133 (formerly C677T or A222V) generates an MTHFR thermolabile enzyme with reduced activity, and the homozygous state of this allele has been associated...