Cardiac hypertrophy and remodeling in relation to ACE and angiotensinogen genes genotypes in Chinese dialysis patients.
BACKGROUND
Genetic polymorphisms of the angiotensinogen (AGT) and angiotensin-converting enzyme (ACE) genes are associated with increased risk of hypertension and left ventricular hypertrophy (LVH) in hypertensive subjects. However, the extent to which these polymorphisms are related to LVH and remodeling in dialysis patients remains unknown.


METHODS
Two hundred and forty-six end-stage renal disease (ESRD) patients on peritoneal dialysis and 183 control subjects, all of Chinese origin, were genotyped for the ACE insertion/deletion (I/D) and the AGT M235T gene polymorphisms. Left ventricular mass index (LVMi) and relative wall thickness were measured using echocardiography.


RESULTS
Prevalence of ACE DD and AGT TT genotype was 14% and 83%, respectively, in ESRD patients and did not differ significantly from controls. A total percentage of 95% of our patients had LVH (171 with concentric and 63 with eccentric hypertrophy). Adjusting for age, gender, body mass index, duration of dialysis, diabetes, renal diagnosis, hematocrit, systolic and diastolic blood pressure, dialysis urea clearance, residual glomerular filtration rate, and use of converting enzyme inhibitors or angiotensin receptor blockers, AGT TT genotype remained independently associated with greater LVMi (coefficient = 28.73; 95% CI, 5.72 to 51.75; P = 0.015) and relative wall thickness (coefficient = 0.072; 95% CI, 0.022 to 0.122; P = 0.005) than MT/MM genotypes. LVMi and relative wall thickness did not differ significantly among patients with DD, DI, and II genotypes. No statistical significant interaction was noted between ACE and AGT gene polymorphism in relation to LVMi and relative wall thickness.


CONCLUSIONS
Polymorphism of the AGT M235T gene but not ACE I/D gene is associated with greater LVMi and relative wall thickness, indicating more concentric LVH, in Chinese peritoneal dialysis patients. Possible synergistic effects between AGT and ACE gene polymorphism require further evaluation in a larger population.
Wang
Angela Yee-Moon
AY
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. awang@cuhk.edu.hk
Chan
Juliana Chung-Ngor
JC
Wang
Mei
M
Poon
Emily
E
Lui
Siu-Fai
SF
Li
Philip Kam-Tao
PK
Sanderson
John
J
D000328:Adult; D000808:Angiotensinogen / Q000235:genetics*; D044466:Asian People / Q000235:genetics; D004452:Echocardiography; D005260:Female; D005838:Genotype; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000208:ethnology / Q000235:genetics*; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000235:genetics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D010530:Peritoneal Dialysis; D011110:Polymorphism, Genetic; D015995:Prevalence; D020257:Ventricular Remodeling / Q000235:genetics*
D000808:Angiotensinogen; D007703:Peptidyl-Dipeptidase A