Analysis of the combined effect of rs699 and rs5051 on angiotensinogen expression and hypertension

Background: Hypertension (HTN) involves genetic variability in the renin-angiotensin system and influences antihypertensive response. We previously reported that angiotensinogen (AGT) messenger RNA (mRNA) is endogenously bound by miR-122-5p and rs699 A > G decreases reporter mRNA in the microRNA functional-assay PASSPORT-seq. TheAGT promoter variant rs5051 C > T is in linkage disequilibrium (LD) with rs699 A > G and increasesAGT transcription. The independent effect of these variants is understudied due to their LD therefore we aimed to test the hypothesis that increasedAGT by rs5051 C > T counterbalancesAGT decreased by rs699 A > G, and when these variants occur independently, it translates to HTN-related phenotypes.Methods: We used in silico, in vitro, in vivo, and retrospective models to test this hypothesis.Results: In silico, rs699 A > G is predicted to increase miR-122-5p binding affinity by 3%. Mir-eCLIP results show rs699 is 40-45 nucleotides from the strongest microRNA-binding site in theAGT mRNA. Unexpectedly, rs699 A > G increasesAGT mRNA in anAGT-plasmid-cDNA HepG2 expression model. Genotype-Tissue Expression (GTEx) and UK Biobank analyses demonstrate liverAGT expression and HTN phenotypes are not different when rs699 A > G occurs independently from rs5051 C > T. However, GTEx and the in vitro experiments suggest rs699 A > G confers cell-type-specific effects onAGT mRNA abundance, and suggest paracrine renal renin-angiotensin-system perturbations could mediate the rs699 A > G associations with HTN.Conclusions: We found that rs5051 C > T and rs699 A > G significantly associate with systolic blood pressure in Black participants in the UK Biobank, demonstrating a fourfold larger effect than in White participants. Further studies are warranted to determine if altered antihypertensive response in Black individuals might be due to rs5051 C > T or rs699 A > G. Studies like this will help clinicians move beyond the use of race as a surrogate for genotype.