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(Hypertension. 2006;47:331.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Early Phenotypic Changes in Hypertension

A Role for the Autonomic Nervous System and Heredity

Elizabeth O. Lillie; Daniel T. O’Connor

From the Departments of Medicine and Pharmacology and Center for Human Genetics and Genomics, University of California at San Diego, and VA San Diego Healthcare System, San Diego, California.

Correspondence to Daniel T. O’Connor, MD, Department of Medicine and Pharmacology and Center for Human Genetics (0838), University of California at San Diego School of Medicine and VA San Diego Healthcare System, 9500 Gilman Dr, La Jolla, CA 92093. E-mail doconnor@ucsd.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Although hypertension is a common trait, its etiology and pathogenesis are not well understood. Despite the increasing understanding of rare Mendelian forms of hypertension,¹ the common variety of hypertension is likely to be a complex trait,² with both hereditary and environmental determination.

In the face of significant heritability yet uncertain mode of inheritance, a useful strategy may be to establish so-called "intermediate phenotypes" (Figure)³: ideally, simple Mendelian or monogenic traits that are associated with hypertension. The disorder may result from alterations in more than one gene, as well as different genes in subgroups of hypertensive subjects; hence, a particular intermediate phenotype may be present in all or only in a subgroup of essential hypertensives. Such a monogenic trait might be more directly determined by the action of a particular gene and, hence, subject to less environmental influence than a complex phenotype such as blood pressure. Thus, an intermediate phenotype might be helpful in identifying those offspring of essential hypertensives who have inherited susceptibility alleles predisposing them to later development of hypertension.

View larger version (16K): [in this window] [in a new window]   The intermediate phenotype concept in hypertension.

Evidence is accumulating for alteration of autonomic function in essential hypertension, especially activation of the sympathetic nervous system,³ which may be involved in not only the genesis of blood pressure elevation but also the progression of target-organ damage. Adrenergic regulation of blood pressure may be altered not only in hypertensives themselves, but also in their (normotensive) first-degree relatives (siblings and offspring): reported adrenergic disturbances in family members include diminished secretion . . . [Full Text of this Article]

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Arnljot Flaa, Håvard H. Mundal, Ivar Eide, Sverre Kjeldsen, and Morten Rostrup
Hypertension 2006 47: 396-402. [Abstract] [Full Text] [PDF]

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