- Proceedings
- Open Access

# Screening the genome to detect an association with hypertension

- Elizabeth J Atkinson
^{1}and - Mariza de Andrade
^{1}Email author

**4 (Suppl 1)**:S63

https://doi.org/10.1186/1471-2156-4-S1-S63

© Atkinson and Andrade; licensee BioMed Central Ltd 2003

**Published:**31 December 2003

## Abstract

We report tree-based association analysis as applied to the two Framingham cohorts and to the first replication of the simulated data obtained from the Genetic Analysis Workshop 13. For this analysis, familial association is ignored. The two endpoints examined are hypertension status at initial visit and time-to-hypertension, using a censored data approach. Although linkage association has previously been reported with hypertension, we found no association using the tree-based methodology.

## Keywords

- Recursive Partitioning
- Hypertension Status
- Simulated Cohort
- Framingham Cohort
- Uninformative Subject

## Background

The Framingham Heart Study is a rich data set filled with information about hypertension status in a population-based cohort observed over an extended period of time. As shown by Levy et al. [1] and Hunt et al. [2], there is strong indication that there is a genetic component to this disease, thus making the data ideal for exploring the strength of tree-based models in detecting similar results. Tree-structure models can be accurate classifiers (binary outcome) and predictors (quantitative outcome), and often yield better understanding to the underlying structure of the data relationship [3]. The use of tree-structure models is advantageous because no assumptions are necessary to explore the data structure and to derive parsimonious models. These models handle data of complex structure and missing data at each node; interactions are part of the tree building process. By using tree-structure methods, we set out to identify homogeneous groups by partitioning the genetic and environmental data using the recursive partitioning algorithm. As shown in Zhang and Bonney [4], classification trees can be used to correctly identify disease alleles. The purpose of this paper is to determine how well the recursive partitioning methodology detected a genetic association using two different measures of hypertension status: hypertension status at the initial visit and a censored data approach, where time is measured on the age scale.

## Materials and Methods

### Data

Our analysis focused on the two Framingham cohorts and the first replicate of the simulated cohorts. Cohort 2 was also used for validation of results obtained from the Cohort 1 analyses. Answers were obtained for the simulated data. In the Framingham study partial data were available on 1213 of the original (largely unrelated) Cohort 1 subjects and 1668 of the original (familial) Cohort 2 subjects. However, in Cohort 1 only 32% of the subjects had genetic marker data; in Cohort 2 the number was much higher (78%) though there were still a large number of uninformative subjects. Although the tree models can handle missing data through the use of surrogate variables, we felt that the large number of observations with completely missing genetic data warranted their deletion. In addition, the age ranges of the two cohorts varied, hence we focused the analysis on the 390 Cohort 1 subjects and the 726 Cohort 2 subjects with genetic marker information who were between 30 and 55 years of age at the initial visit. Similar limiting of the simulated data resulted in 346 Cohort 1 subjects and 1060 Cohort 2 subjects. We defined two primary response variables based on the available phenotype data and models were fit separately for each of the two cohorts. We first looked at hypertension status at the baseline visit (22% of Framingham Cohort 1, 20% of Framingham Cohort 2, 6% of Simulated Cohort 1, and 8% of Simulated Cohort 2). Three Framingham Cohort 2 subjects who were being treated for hypertension at the baseline visit but were not diagnosed with hypertension were removed from the analysis. Our second end-point used a censored "time-to-hypertension" approach, in which age was used as the time scale. Subjects entered the risk set at their first visit and exited the risk set when they were lost to follow up (censored) or were diagnosed with hypertension. For those subjects that did not already have hypertension at their first visit, 52% of Framingham Cohort 1 and 29% of the Framingham Cohort 2 went on to develop the disease by age 55. The simulated cohorts each had estimates around 30% at age 55. Subjects who started treatment for hypertension before diagnosis of hypertension were censored at the time of treatment (this occurred in less that 2% of the subjects in each cohort). The 398 genetic markers were used as predictors along with the environmental variables of age, sex, cigarettes per day, body mass index, and alcohol consumption. The markers were expanded so that every allele of every marker created a new allelic variable. For instance, chromosome 1, marker 1, allele 1 (c1m1a1) could have the values 0, 1, or 2 depending on how many copies of the mutation an individual carried. This resulted in the creation of over 4400 predictors.

### Statistical methods

_{ iA }is the proportion of those in node A that belong to class

*i*, and

*f*is some impurity function. If node A is pure then I(A) = 0. For the classification end-point "hypertension at visit one" we used the impurity function called the Gini index where

*f*(p) = p(1 - p) and we used the split which maximized the impurity reduction Δ

*I*=

*p*(

*A*

_{ Parent })

*I*(

*A*

_{ Parent }) -

*p*(

*A*

_{ Left })

*I*(

*A*

_{ Left }) -

*p*(

*A*

_{ Right })

*I*(

*A*

_{ Right }). For the censored "time-to-hypertension" end-point we used a splitting criterion which is equivalent to a likelihood ratio test for two Poisson groups:

*D*

_{ Parent }- (

*D*

_{ Left }+

*D*

_{ Right }). The deviance , where c

_{ i }is the observed event count for observation

*i*, t

_{ i }is the scaled observation time, and is the predicted rate of the node. The time variable is modified slightly using exponential scaling to get a straight line curve for log(survival) under a parametric exponential model [5]. This is equivalent to the local full likelihood tree model by LeBlanc and Crowley [6].

For pruning we chose to use a fixed complexity parameter of 5% and the 1-SE rule. The complexity parameter α is a measure of improvement in the tree impurity. Heuristically, the tree building process can be compared to forward step-wise regression, where variables (splits) are made until the F-test of the remaining variables fails to achieve some level of α. An α level of 5% suggests that further splits will add less than 5% to the overall fit of the tree. The 1-SE rule uses cross-validation, which involves randomly partitioning the original samples into 10 fitted sub-samples and computing an average misclassification rate for each sub-tree (corresponding to the different splits). The sub-tree with the smallest average misclassification rate is identified, as are all sub-trees that have an average misclassification rate within one standard error of this smallest rate (also obtained from the cross-validation). The simplest model is picked. Thus, we identified a sub-tree that provides the least complexity and the least misclassification of subjects. All recursive partitioning models were fit using the SPLUS library rpart [5], a package that closely resembles the original CART package [3].

## Results

### Hypertension status at Visit 1

Analysis of the Framingham Cohort 1 data examining "hypertension at visit one" as built to the complexity parameter of 5% includes the environmental variables age and body mass index (BMI), and 11 different markers: c10m5a5, c12m17a7, c17m7a7, c19m8a1, c1m32a4, c2m21a3, c2m21a6, c2m2a11, c5m20a1, c6m12a7 and c6m13a7. No variables remain in the model after pruning using the 1-SE rule. Results are similar when only marker data is used or when only a subset of the marker data is used (using alleles that appear > 1% or < 99% of the time results in 30% fewer allele variables). Analysis of the Framingham Cohort 2 data resulted in similar conclusions, with no variables remaining after pruning with the 1-SE rule.

^{th}decimal point.

Misclassification rates of the Framingham Cohort 1 models predicting hypertension at visit 1.

Model | Number of End-nodes | Cohort 1 Observed Error | Cohort 1 Cross-validation | Cohort 1 Model Applied to Cohort 2 |
---|---|---|---|---|

1) No Splits | 1 | 22.1% | 22.1% | 20.2% |

2) All M & E | 3 | 18.5% | 23.1% | 21.6% |

3) All M | 5 | 17.4% | 26.9% | 22.7% |

4) All E, subset of M | 3 | 18.5% | 23.1% | 21.6% |

Misclassification rates of the simulated (Replication 1) Cohort 1 models predicting hypertension at visit 1.

Model | Number of End-nodes | Cohort 1 Observed Error | Cohort 1 Cross-validation | Cohort 1 Model applied to Cohort 2 |
---|---|---|---|---|

1) No Splits | 1 | 6.4% | 6.4% | 7.9% |

2) All M & E | 3 | 5.5% | 6.6% | 10.1% |

3) All M | 3 | 5.5% | 6.6% | 10.1% |

4) All E, subset of M | 3 | 5.5% | 6.6% | 10.1% |

5) All E, handpicked M | 1 | 6.4% | 6.4% | 7.9% |

### Time-to-hypertension

## Discussion

Although the recursive partitioning approach should be ideal for detecting sub-populations of individuals that have hypertension, we were unable to detect any association between the hypertension status and the 398 genetic markers. Similarly, because hypertension is highly age-related the end-point using a censored "time-to-hypertension" approach, where age was used as the time scale, should have been useful for separating out subjects who perhaps had earlier onset of the disease. Neither methodology found any consistent positive results. A large proportion of the subjects did not have genetic marker data and were thus deleted (68% of the Framingham Cohort 1 subjects and 22% of the Cohort 2 subjects) whereas in a familial analysis some of the markers could have been estimated from family members. In the Framingham Cohort 1, those without marker data were on average older, heavier, smoked more, drank more and had, at baseline, more hypertension (41.5% vs. 22.1%). The same patterns were also seen in Cohort 2, though the differences were not as great. Because the missing patterns are significantly related to hypertension status, this probably introduced bias into the study, perhaps making meaningful associations more difficult to find. Another problem could be that hypertension is too common a condition for study using this methodology (the cumulative incidence at age 80 is over 80% (Figure 1). The censoring of data when hypertension treatment preceded diagnosis occurred in less than 10% of the cases, but might have marginally influenced the results. However, it is unclear how those subjects should be coded since time to diagnosis would surely be influenced by treatment. Finally, perhaps sample size was an issue, especially in Cohort 1, in which 390 subjects were used for the case/control status and 304 subjects were used for the "time-to-hypertension" endpoint.

## Authors’ Affiliations

## References

- Levy D, DeStefano AL, Larson MG, O'Donnell CJ, Lifton RP, Gavras H, Cupples LA, Myers RH: Evidence for a gene influencing blood pressure on chromosome 17. Genome scan linkage results for longitudinal blood pressure phenotypes in subjects from the Framingham Heart Study. Hypertension. 2000, 36: 477-483.View ArticlePubMedGoogle Scholar
- Hunt SC, Ellison RC, Atwood LD, Pankow JS, Province MA, Leppert MF: Genome scans for blood pressure and hypertension – The National Heart, Lung, and Blood Institute Family Heart Study. Hypertension. 2002, 40: 1-6. 10.1161/01.HYP.0000022660.28915.B1.View ArticlePubMedGoogle Scholar
- Breiman L, Friedman JH, Olshen RA, Stone CJ: Classification and regression trees. New York, Chapman and Hall. 1984Google Scholar
- Zhang HP, Bonney G: Use of classification trees for association studies. Genet Epidemiol. 2000, 19: 323-332. 10.1002/1098-2272(200012)19:4<323::AID-GEPI4>3.0.CO;2-5.View ArticlePubMedGoogle Scholar
- Therneau TM, Atkinson EJ: An Introduction to Recursive Partitioning Using the RPART Routines. Technical Report #61. Rochester, MN, Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Rochester. 1997Google Scholar
- LeBlanc M, Crowley J: Relative risk trees for censored survival data. Biometrics. 1992, 48: 411-425. 10.2307/2532300.View ArticlePubMedGoogle Scholar

## Copyright

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.