Genome-wide analysis in over 1 million individuals of European ancestry yields improved polygenic risk scores for blood pressure traits.

Acknowledgements: J.N.H. is supported by the National Institutes of Health (grant no. K12HD04348; principal investigator K. E. Hartmann). T.E. and A.M. were supported by the Council of Europe (grant no. 2014-2020.4.01.15-0012) and Estonian Research Council (grant no. PRG1291). Z.K. is supported by Isfahan University of Medical Sciences (3400581) and Iran’s National Elites Foundation (grant no. ISF140100108). J.N.D. holds a British Heart Foundation Professorship and a National Institute for Health Research Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Cohort support was provided by the Million Veteran Program (MVP) VA Award BX004821 (to P.W.F.W. and K.C.). Individual cohort acknowledgements are provided in the Supplementary Notes. We dedicate this paper to the memory of Evangelos Evangelou (the first author of our previous BP-GWAS paper5), who sadly passed away in July 2023. ; Hypertension affects more than one billion people worldwide. Here we identify 113 novel loci, reporting a total of 2,103 independent genetic signals (P < 5 × 10-8) from the largest single-stage blood pressure (BP) genome-wide association study to date (n = 1,028,980 European individuals). These associations explain more than 60% of single nucleotide polymorphism-based BP heritability. Comparing top versus bottom deciles of polygenic risk scores (PRSs) reveals clinically meaningful differences in BP (16.9 mmHg systolic BP, 95% CI, 15.5-18.2 mmHg, P = 2.22 × 10-126) and more than a sevenfold higher odds of hypertension risk (odds ratio, 7.33; 95% CI, 5.54-9.70; P = 4.13 × 10-44) in an independent dataset. Adding PRS into hypertension-prediction models increased the area under the receiver operating characteristic curve (AUROC) from 0.791 (95% CI, 0.781-0.801) to 0.826 (95% CI, 0.817-0.836, ∆AUROC, 0.035, P = 1.98 × 10-34). We compare the 2,103 loci results in non-European ancestries and show significant PRS associations in ...