A Large-Scale Genome-wide Association Study of Blood Pressure Accounting for Gene-Depressive Symptomatology Interactions in 564,680 Individuals from Diverse Populations

Background: Gene-environment interactions may enhance our understanding of hypertension. Our previous study highlighted the importance of considering psychosocial factors in gene discovery for blood pressure (BP) but was limited in statistical power and population diversity. To address these challenges, we conducted a multi-population GWAS of BP accounting for gene-depressive symptomatology (DEPR) interactions in a larger and more diverse sample.
Results: Our study included 564,680 adults aged 18 years or older from 67 cohorts and 4 population groups (African (5%), Asian (7%), European (85%), and Hispanic (3%)). We discovered seven novel gene-DEPR interaction loci for BP traits (P < 5 x 10-8). These loci mapped to genes implicated in neurogenesis (TGFA, CASP3), lipid metabolism (ACSL1), neuronal apoptosis (CASP3), and synaptic activity (CNTN6, DBI). We also identified evidence for gene-DPER interaction at nine known BP loci, further suggesting links between mood disturbance and BP regulation. Of the 16 identified loci, nearly 70% were derived from non-European populations. Functional annotation analyses prioritized 36 genes, including genes involved in synaptic functions (DOCK4, MAGI2) and neuronal signaling (CCK, UGDH, SLC01A2). Integrative druggability analyses identified 11 druggable candidate gene targets, including genes implicated in pathways linked to mood disorders as well as gene targets of known hypertension drugs. 
Conclusions: Our findings emphasize the importance of considering gene-DEPR interaction effects on BP, particularly in non-European populations. Our prioritized genes and druggable targets highlight biological pathways connecting mood disorders and hypertension, and suggest opportunities for BP drug repurposing and risk factor prevention, especially in individuals with DEPR.