Abstract Body: Background: High heritability of salt sensitivity suggests an essential role for genetics in the relationship between sodium intake and blood pressure (BP). The role of glycosaminoglycan (GAG) genes, which are crucial for salinity tolerance througout evolution, remains to be elucidated.

Methods: Interactions between 54,126 variants in 130 GAG genes and daily sodium excretion on BP were explored in 20,420 EPIC-Norfolk subjects. UK Biobank (n=414,132) and the multi-ethnic HELIUS study (n=2,239, comprising a balanced representation of people from European, Subsaharan, South Asian, Turkish, and Moroccan descent) were used for validation. Afterwards, urinary GAG composition was studied in HELIUS participants (n=57) stratified by genotype, and upon dietary sodium loading in a time-controlled crossover intervention study (n=12).

Results: rs2892799 (NDST3) showed the strongest interaction with sodium on mean arterial pressure (MAP) (FDR 0.03), with higher MAP for the C-allele in high sodium conditions. Also, rs9654628 (HS3ST5) showed an interaction with sodium on systolic BP (FDR 0.03). These interactions were multi-ethnically validated (figures A and B, respectively). Stratifying for rs2892799 genotype, showed higher urinary expression of N-sulfated heparan sulfate epitope D0S0 for the T-allele. Conversely, upon dietary sodium loading, urinary D0S0 expression was higher in participants with stable BP after sodium loading, and sodium-induced effects on this epitope were opposite in individuals with and without BP response to sodium.

Conclusion: The C-allele of rs2892799 (NDST3) exhibits higher BP in high sodium conditions when compared to low sodium conditions, whereas no differences were detected for the T-allele. Concomitantly, both alleles demonstrate distinct expressions of D0S0, which, in turn, correlates with sodium-mediated BP elevation. These findings underscore the potential significance of genetic GAG variation in human BP regulation.