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Original research
Genetic screening for monogenic hypertension in hypertensive individuals in a clinical setting
  1. Minghui Bao1,
  2. Ping Li2,
  3. Qifu Li3,
  4. Hui Chen4,
  5. Ying Zhong5,
  6. Shuangyue Li6,
  7. Ling Jin6,
  8. Wenjie Wang6,
  9. Zhenzhen Chen6,
  10. Jiuchang Zhong7,
  11. Bin Geng6,
  12. Yuxin Fan8,
  13. Xinchun Yang7,
  14. Jun Cai6
  1. 1 Department of Cardiology, Peking University First Hospital, Peking University, Beijing, China
  2. 2 Department of Cardiovascular Medicine, Nanchang University Second Affiliated Hospital, Nanchang, China
  3. 3 Department of Endocrinology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
  4. 4 Department of Internal Medicine, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
  5. 5 Novogene Science and Technology Co., Ltd, Beijing, China
  6. 6 Hypertension Center of Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  7. 7 Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
  8. 8 The John Welsh Cardiovascular Diagnostic Laboratory, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Jun Cai, Hypertension Center, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China; caijun{at}


Background Monogenic hypertension describe a series of hypertensive syndromes that are inherited by Mendelian laws. Sometimes genetic testing is required to provide evidence for their diagnoses, precise classification and targeted treatment. This study is the first to investigate the clinical utility of a causative gene screening and the combined yield of gene product expression analyses in cases with suspected monogenic hypertension.

Methods We performed a large-scale multi-centre clinical genetic research of 1179 expertly selected hypertensive individuals from the Chinese Han population. Targeted sequencing were performed to evaluate 37 causative genes of potential cases of monogenic hypertension. Pathogenic and likely pathogenic variants were classified using the American College of Medical Genetics guidelines. Additionally, 49 variants of unknown significance (VUS) that had relatively high pathogenicity were selected and analysed using immunoblot protein expression assays.

Results 21 pathogenic or likely pathogenic variants were identified in 33 of 1179 cases (2.80%). Gene product expression analyses showed 27 VUSs harboured by 49 individuals (4.16%) could lead to abnormally expressed protein levels. Consequently, combining genetic screening with gene product expression analyses increased the diagnostic yield from 2.80% to 6.79%. The main aetiologies established were primary aldosteronism (PA; 27, 2.29%) and pheochromocytoma and paraganglioma (PPGL; 10, 0.85%).

Conclusion Molecular diagnoses obtained using causative gene screening combined with gene product expression analyses initially achieved a modest diagnostic yield. Our data highlight the predominant roles of PA and PPGL. Furthermore, we provide evidence indicating the enhanced diagnostic ability of combined genetic and functional evaluation.

  • clinical genetics
  • diagnosis
  • hypertension
  • genetic screening/counselling

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  • Contributors JC, XY, YF and BG were responsible for the study design and conception. PL, QL and HC contributed to the sample collection. MB and YZ dealt with the clinical data collection and assembly. MB, YZ, SL, LJ, WW, ZC and JZ contributed to the sequencing data analysis and interpretation. MB drafted the manuscript. All authors participated in revising this manuscript. MB submitted the manuscript.

  • Funding This work was supported by National Natural Science Foundation of China (8167020374) and Beijing Natural Science Foundation (17G10314).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Board of Peking Union Medical College Fuwai Hospital (ID: 2016GEC012).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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