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Background: Hypertension, a leading risk factor for cardiovascular disease, exhibited in 17.7% of the Canadian population, and attributed to 13% of world mortality, is influenced by both the environment and genetics. Salt sensitivity is described at higher rates in the hypertensive population. The NEDD4-like (NEDD4L) protein is important in sodium reabsorption and has been implicated in essential hypertension and salt sensitivity. Objectives: Two variations (rs4149601/rs2288774) found in NEDD4L have been associated with salt sensitivity and hypertension; a third (rs576416) is in linkage disequilibrium with rs4149601. The purpose of this study is to assess the relationship between the NEDD4L rs4149601, rs2288774, and rs576416 single nucleotide polymorphisms with sodium and age on blood pressure (BP). Methods: Canadian hypertensive patients were recruited through the University of Ottawa Heart Institute, with genotyped data from Leuven, Belgium, and the DNA of subjects from Warsaw, Poland also included in the study. Eligible subjects were studied off anti-hypertensive medications. Daytime BP was measured using 24hr ambulatory BP monitoring in 662 Caucasian hypertensives (BP ≥130/85 mmHg). 24hr urine Na+ was collected. DNA from Canada and Poland was genotyped on the GeneTitan Affymetrix Axiom platform and through TaqMan MGB probe-based RT-PCR, while the Belgium samples were analyzed on Illumina 1M-duo arrays. Simple and multivariate linear regression modelling with SAS 9.4.0 was used for genotypic comparisons affecting BP, combined with age and corrected urine sodium. Results: The three hypertensive populations were significantly different (P |