Angiotensin-converting enzyme gene polymorphism and reversibility of uremic left ventricular hypertrophy following long-term antihypertensive therapy.
BACKGROUND
Prolonged antihypertensive therapy might be less effective in reversing the left ventricular hypertrophy (LVH) in uremics bearing the deleted (DD) allele of the angiotensin converting enzyme (ACE) gene than in patients with the inserted (II) allele or in those heterozygous (ID) for the gene.


METHODS
Thirteen DD and 17 II + ID hemodialyzed uremics were followed-up with yearly echocardiography and 24-hour blood pressure (BP) monitoring over five years while on an antihypertensive therapy that included ACE inhibitors as first line drugs.


RESULTS
In the II + ID group there were significant decreases of the left ventricular mass index (LVMi) and of both systolic and diastolic BPs. These changes were less pronounced in the DD group, but the difference was not statistically significant given the wide overlap between the two groups. Further analysis of the data revealed that the only factor associated to a decreased LVMi was the decrease of the systolic BP irrespective of the ACE gene genotype of each individual patient.


CONCLUSIONS
The ACE-gene genotype does not necessarily predict the extent to which LVMi will be lowered by ACE-inhibitors therapy. The LVH of hypertensive uremics is amenable by long-term antihypertensive therapy provided that it results in significantly decreased systolic blood pressure.
Divisione di Nefrologia e Dialisi, Laboratorio di Immunologia, Istituto di Statistica Medica dell'Università, Genova, Italy. gcannella@smartino.ge.it
G
G
Cannella
E
E
Paoletti
S
S
Barocci
F
F
Massarino
R
R
Delfino
G
G
Ravera
G
G
Di Maio
A
A
Nocera
P
P
Patrone
D
D
Rolla
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D005838:Genotype; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic; D014511:Uremia / Q000150:complications* / Q000235:genetics
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007703:Peptidyl-Dipeptidase A