Abstract-Albuminuria increases the risk of cardiovascular events in patients with essential hypertension and diabetic subjects. The heritability (h 2 ) of albuminuria in multiplex hypertensive families is unknown. We calculated the familial aggregation of urine albumin:creatinine ratio (ACR) and performed a genome-wide scan to assess for loci contributing to ACR in participants enrolled in the Hypertension Genetic Epidemiology Network (HyperGEN). To perform the genome scan, we analyzed genotype results from 2589 individuals from 805 families in the Family Blood Pressure Program. ACR and covariates were available in 1727 individuals (mean age, 57.1 years). Estimates of h 2 were obtained by using variance component methodology as implemented in the SOLAR software package. Linkage was tested between 387 markers spanning the genome at an average interval of 9.32 cM, using SOLAR multipoint analysis. The h 2 of log urine ACR was 0.49 (PϽ1ϫ10
Ϫ7) after controlling for significant main and interactive effects of age, gender, race, body mass index, blood pressure, and use of ACE inhibitors or angiotensin-2 receptor blockers. The genome-wide scan revealed a maximum LOD score of 2.73 on chromosome 19 (robust corrected LOD, 2.40; Pϭ0.0009) at marker D19S591 and a LOD score of 2.0 on chromosome 12 (robust corrected LOD, 1.75; Pϭ0.005) at marker PAH. These analyses demonstrate the marked heritability of urine ACR in families enriched for the presence of members with essential hypertension. They suggest that a gene(s) associated with urinary ACR may be present on human chromosomes 19 and 12. Key Words: albuminuria Ⅲ nephrosclerosis Ⅲ blacks Ⅲ race Ⅲ hypertension, essential T he heritability and role of inherited factors in the causation of elevated urinary albumin excretion (UAE) among hypertensive subjects remain unknown. Several reports reveal that albuminuria clusters tightly in the diabetic and nondiabetic members of multiplex families with type 2 diabetes mellitus. 1,2 The presence of microalbuminuria in diabetic individuals portends an increased risk for development of progressive renal failure and subsequent end-stage renal disease (ESRD). In and of itself, ESRD has a strong familial component in diabetes and hypertension. 3 Elevated levels of UAE in diabetic individuals are associated with increased rates of cardiovascular morbidity and mortality. 4 In hypertensive subjects, microalbuminuria is a risk factor for premature cardiovascular morbidity and mortality. 5,6 The most recent Joint National Commission on Hypertension (JNC VII) report 7 includes microalbuminuria as evidence for the presence of target organ damage. Target organ damage indicates the need for more aggressive control of blood pressure.It is likely that both genetic and environmental factors contribute to UAE in hypertensive individuals. The fawn-hooded rat, 8 Munich Wistar Fromter rat, 9 and Dahl salt-sensitive rat 10 models of hypertensive nephropathy suggest that the genes regulating UAE are independent of those that regulate blood pressure.Previous ...