Renovascular disease: effect of ACE gene deletion polymorphism and endovascular revascularization.
BACKGROUND
Renal artery stenosis (RAS) is associated with high cardiovascular mortality and significant clinical complications, including resistant hypertension and ischemic nephropathy. Despite availability of endovascular revascularization techniques, determining which patients should undergo revascularization and the timing of the procedure still are controversial. Several studies have reported a higher frequency of the DD genotype of the insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene in patients with RAS, and one study found higher mortality in patients with the DD genotype. Material and methods We retrospectively studied 100 patients with documented atherosclerotic RAS and evaluated long-term (median follow-up, 28 months) mortality, blood pressure control, and renal function in relation to the ACE genotype and two therapeutic strategies, that is, endovascular treatment with percutaneous renal transluminal angioplasty or stenting (ET group) versus conservative drug therapy (CT group).


RESULTS
Comparison between therapeutic groups showed a higher cumulative probability of survival (86.7% vs 67.1%), better blood pressure control (57.4% vs 29%), and slower decline in renal function (17.9% vs 48.4%) in the ET group. The DD genotype was strongly represented in our study patients (DD, 50%; II, 15.5%; I/D, 34.5%), but bore no relation to mortality, blood pressure control, decline in renal function, or rate of recurrent stenosis.


CONCLUSIONS
Conservative medical treatment of RAS, compared with endovascular treatment, is associated with higher mortality, poorer blood pressure control, and impaired renal function over the long term. Early endovascular treatment enables amelioration of this unfavorable evolution. The DD genotype does not predict clinical outcome of RAS.
Pizzolo
Francesca
F
Section of Internal Medicine, Department of Clinical and Experimental Medicine, University of Verona, Policlinico Borgo Roma, 37134 Verona, Italy.
Mansueto
Giancarlo
G
Minniti
Salvatore
S
Mazzi
Mariangela
M
Trabetti
Elisabetta
E
Girelli
Domenico
D
Corrocher
Roberto
R
Olivieri
Oliviero
O
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001161:Arteriosclerosis / Q000235:genetics / Q000601:surgery; D001794:Blood Pressure; D005260:Female; D017353:Gene Deletion; D006720:Homozygote; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D007703:Peptidyl-Dipeptidase A / Q000235:genetics; D011110:Polymorphism, Genetic; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000235:genetics* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate
D007703:Peptidyl-Dipeptidase A