Impact of the common MTHFR 677C→T polymorphism on blood pressure in adulthood and role of riboflavin in modifying the genetic risk of hypertension: evidence from the JINGO project

M Ward, Catherine Hughes, J.J. Strain, Rosie Reilly, Conal Cunningham, Anne Molloy, Geraldine Horigan, Miriam Casey, Kevin McCarroll, Maurice O'Kane, Michael Gibney, Albert Flynn, Janette Walton, Breige McNulty, Adrian McCann, Laura Kirwan, John Scott, H McNulty

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Genome-wide and clinical studies have linked the 677C→T polymorphism in the gene encoding methylenetetrahydrofolate reductase (MTHFR) with hypertension, whilst limited evidence shows that intervention with riboflavin (i.e. the MTHFR co-factor) can lower blood pressure (BP) in hypertensive patients with the variant MTHFR 677TT genotype. We investigated the impact of this common polymorphism on BP throughout adulthood and hypothesised that riboflavin status would modulate the genetic risk of hypertension. Observational data on 6076 adults of 18-102 years were drawn from the Joint Irish Nutrigenomics Organisation project, comprising the Trinity-Ulster Department of Agriculture (TUDA; volunteer sample) and the National Adult Nutrition Survey (NANS; population-based sample) cohorts. Participants were recruited from the Republic of Ireland and Northern Ireland (UK) in 2008-2012 using standardised methods. The variant MTHFR 677TT genotype was identified in 12% of adults. From 18 to 70 years, this genotype was associated with an increased risk of hypertension (i.e. systolic BP ≥ 140 and/or a diastolic BP ≥ 90 mmHg): odds ratio (OR) 1.42, 95% confidence interval (CI) 1.07 to 1.90; P = 0.016, after adjustment for antihypertensive drug use and other significant factors, namely, age, male sex, BMI, alcohol and total cholesterol. Low or deficient biomarker status of riboflavin (observed in 30.2% and 30.0% of participants, respectively) exacerbated the genetic risk of hypertension, with a 3-fold increased risk for the TT genotype in combination with deficient riboflavin status (OR 3.00, 95% CI, 1.34-6.68; P = 0.007) relative to the CC genotype combined with normal riboflavin status. Up to 65 years, we observed poorer BP control rates on antihypertensive treatment in participants with the TT genotype (30%) compared to those without this variant, CT (37%) and CC (45%) genotypes (P 
Original languageEnglish
Article number318
Pages (from-to)318
Number of pages11
JournalBMC Medicine
Issue number1
Publication statusPublished (in print/issue) - 11 Nov 2020

Bibliographical note

Funding Information:
Supported by governmental funding from the Irish Department of Agriculture, Food and the Marine and Health Research Board (under the Food Institutional Research Measure, FIRM, initiative) and from the Northern Ireland Department for Employment and Learning (under its Strengthening the All-Island Research Base initiative). The work combines two studies completed as part of an All-Ireland initiative under the Joint Irish Nutrigenomics Organisation, JINGO. The funders had no role in the study design, in the collection, analysis or interpretation of the data, in the writing of the report, or in the decision to submit for publication. Acknowledgements

Publisher Copyright:
© 2020, The Author(s).

Copyright 2021 Elsevier B.V., All rights reserved.


  • Blood pressure
  • Folate polymorphism
  • Hypertension
  • Personalised treatment
  • Prevention
  • Riboflavin


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