Angiotensin-converting enzyme insertion/deletion polymorphism, 24-h blood pressure profile and left ventricular hypertrophy in hypertensive individuals: a cross-sectional study.
BACKGROUND
The absence of nocturnal blood pressure dipping (ND) identified by 24-h ambulatory blood pressure monitoring (ABPM) correlates with a worse cardiovascular prognosis. The renin-angiotensin system influences blood pressure levels and the occurrence of target organ damage (TOD). Thus, the aim of this study was to correlate the angiotensin-converting enzyme gene (ACE) insertion/deletion (I/D) polymorphism with the 24-h blood pressure profile and TOD in hypertensive individuals.


METHODS
155 non-diabetic hypertensive individuals on antihypertensive treatment underwent ABPM. Peripheral blood samples were drawn for biochemistry and genetic analysis of the ACE I/D polymorphism by polymerase chain reaction. ND was defined as ≥10 % differences in the mean systolic blood pressure (BP) during wakefulness and sleep.


RESULTS
There were no differences in clinical or biochemical variables or TOD in respect to ND status, except for higher BP levels during sleep (p < 0.001) in non-dippers. There was significant difference in the prevalence of left ventricular hypertrophy (LVH) between ACE genotypes (II: 13.0 %; ID: 34.1 %; DD: 46.5 %; p value = 0.024) with an increased risk in carriers of the DD genotype (OR = 5.80; IC 95 % 1.50-22.44; p value = 0.011). Carriers of the D allele had higher systolic BP during wakefulness and by ABPM (p < 0.05), higher left ventricular mass (117.3 ± 50.0 vs. 100.3 ± 25.7; p value = 0.017) and higher prevalence of LVH (37.4 vs. 12.5 %; OR = 4.14; 95 % IC: 1.17-14.65; p value = 0.028), compared to the II genotype.


CONCLUSIONS
The DD genotype is associated with a higher prevalence of LVH. The presence of the D allele appears to be associated with higher mean 24-h and wake systolic BP measured by ABPM in hypertensive patients under antihypertensive treatment.
Hypertension Clinic, Internal Medicine Department, State Medical School in São José do Rio Preto (FAMERP) and Hospital de Base, Ave Brig. Faria Lima 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil. luciana-martin@uol.com.br.
Luciana Neves
LN
Cosenso-Martin
Hypertension Clinic, Internal Medicine Department, State Medical School in São José do Rio Preto (FAMERP) and Hospital de Base, Ave Brig. Faria Lima 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil. vilelamartinjf@gmail.com.
Renan Oliveira
RO
Vaz-de-Melo
Hypertension Clinic, Internal Medicine Department, State Medical School in São José do Rio Preto (FAMERP) and Hospital de Base, Ave Brig. Faria Lima 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil. vilelamartin@gmail.com.
Luana Rocco
LR
Pereira
Hypertension Clinic, Internal Medicine Department, State Medical School in São José do Rio Preto (FAMERP) and Hospital de Base, Ave Brig. Faria Lima 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil. claudiacesarino@famerp.br.
Cláudia Bernardi
CB
Cesarino
Hypertension Clinic, Internal Medicine Department, State Medical School in São José do Rio Preto (FAMERP) and Hospital de Base, Ave Brig. Faria Lima 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil. vilelamartin@cardiol.br.
Juan Carlos
JC
Yugar-Toledo
Hypertension Clinic, Internal Medicine Department, State Medical School in São José do Rio Preto (FAMERP) and Hospital de Base, Ave Brig. Faria Lima 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil. j.cipullo@terra.com.br.
José Paulo
JP
Cipullo
Molecular Biology Department, FAMERP, São Paulo, Brazil. marcelapinhel@yahoo.com.br.
Marcela Augusta
MA
de Souza Pinhel
Molecular Biology Department, FAMERP, São Paulo, Brazil. doroteia@famerp.br.
Dorotéia Rossi Silva
DR
Souza
Hypertension Clinic, Internal Medicine Department, State Medical School in São José do Rio Preto (FAMERP) and Hospital de Base, Ave Brig. Faria Lima 5416, São José do Rio Preto, São Paulo, 15090-000, Brazil. vilelamartin@uol.com.br.
José Fernando
JF
Vilela-Martin
D000368:Aged; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000201:enzymology* / Q000235:genetics / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000235:genetics* / Q000503:physiopathology; D054643:INDEL Mutation; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*
D007703:Peptidyl-Dipeptidase A