title: Does the Angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism modify the response to ACE inhibitor therapy?--A systematic review.
abstract: BACKGROUND
  Pharmacogenetic testing to individualize ACE inhibitor therapy remains controversial. We conducted a systematic review to assess the effect modification of the insertion/deletion (I/D) polymorphism of the ACE gene on any outcome in patients treated with ACE inhibitors for cardiovascular and/or renal disease.
  
  
  METHODS
  Our systematic review involved searching six electronic databases, then contacting the investigators (and pharmaceutical industry representatives) responsible for the creation of these databases. Two reviewers independently selected relevant randomized, placebo-controlled trials and abstracted from each study details on characteristics and quality.
  
  
  RESULTS
  Eleven studies met our inclusion criteria. Despite repeated efforts to contact authors, only four of the eleven studies provided sufficient data to quantify the effect modification by genotypes. We observed a trend towards better response to ACE inhibitors in Caucasian DD carriers compared to II carriers, in terms of blood pressure, proteinuria, glomerular filtration rate, ACE activity and progression to end-stage renal failure. Pooling of the results was inappropriate, due to heterogeneity in ethnicity, clinical domains and outcomes.
  
  
  CONCLUSIONS
  Lack of sufficient genetic data from the reviewed studies precluded drawing any convincing conclusions. Better reporting of genetic data are needed to confirm our preliminary observations concerning better response to ACE inhibitors among Caucasian DD carriers as compared to II carriers.
authors.affiliation: Horten Centre for patient oriented research, University of Zurich, Switzerland. madlaina.scharplatz@usz.ch
authors.forename: Madlaina
authors.initials: M
authors.lastname: Scharplatz
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
authors.forename: Johann
authors.initials: J
authors.lastname: Steurer
authors.forename: Annalisa
authors.initials: A
authors.lastname: Perna
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann