Systemic Hypertension
Cardiovascular risk factors, angiotensin-converting enzyme gene I/D polymorphism, and left ventricular mass in systemic hypertension☆

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Abstract

We investigated the influence of major cardiovascular risk factors (smoking, hypercholesterolemia, diabetes mellitus) on the association between angiotensin-converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphism and echocardiographic left ventricular mass in 225 patients with sustained hypertension, assessed by ambulatory blood pressure monitoring. When the study population was analyzed as a whole, the 3 ACE genotypes did not differ in left ventricular mass (II, 47 g/m2.7; ID, 49 g/m2.7; DD, 51 g/m2.7; p = NS). No difference was found in subjects (n = 135) in whom at least 1 major cardiovascular risk factor was present (II, 51 g/m2.7; ID, 51 g/m2.7; DD: 52 g/m2.7; p = NS). In contrast, in the absence of cardiovascular risk factors, DD subjects (n = 32) exhibited left ventricular mass index higher than non-DD (ID/II) subjects (n = 75; p <0.05). After controlling for age and sex, in the absence of cardiovascular risk factors, the risk of left ventricular hypertrophy was 3.8-fold higher in DD than in non-DD patients (odds ratio 3.8; 95% confidence interval 1.2 to 12.1, p <0.02). We conclude that in the present setting of patients with established sustained systemic hypertension, the absence of risk factors potentially affecting cardiovascular adaptation allows for the detection of a positive association between homozygosity for the D allele of the ACE gene and left ventricular hypertrophy.

Section snippets

Subjects

All patients were preliminarily asked to give their informed consent to enter the study. After excluding subjects with coronary heart disease (as judged by clinical examination, standard 12-lead electrocardiogram and/or presence of wall motion abnormality by 2-dimensional echocardiography), valvular heart disease (2-dimensional Doppler echocardiography), secondary hypertension, dilated cardiomyopathy, left bundle branch block, thyroid disease, or treatment with oral contraceptives, 225

Genotype frequencies and clinical characteristics of the study population

Table Ilists the characteristics of the study population stratified according to ACE I/D genotypes. Homozygosity for the D allele (DD genotype) was present in 33%; homozygosity for the I allele (II) was found in 16%. These frequencies were compared with those predicted from the Hardy-Weinberg equilibrium in the general population. No significant difference was observed (chi-square), nor was any difference found in clinical or ambulatory blood pressure or in left ventricular geometry. The

Discussion

In a case-control study, Cambien et al16 reported that the association between myocardial infarction and the DD genotype of the ACE gene could be detected only in patients without major cardiovascular risk factors (low-risk patients). This finding has recently been confirmed by coronary angiography in a large cohort of 920 men.21 Moreover, in the study by Mattu et al,22 a significant association between DD genotype and coronary lesions was detected only in low-risk patients.

The role of

References (25)

  • X Jeunemaitre et al.

    Absence of linkage between the angiotensin converting enzyme gene polymorphism and human essential hypertension

    Nature Genet

    (1992)
  • N Iwai et al.

    DD genotype of the angiotensin converting enzyme gene is a risk factor for left ventricular hypertrophy

    Circulation

    (1994)

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    ☆

    This study was supported in part by Grant MURST-185/1995-1996 of the Italian Ministry of University and Research.

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