Julve R, Chaves F J, Rovira E, Pascual J M, Miralles A, Armengod M E, Redon J
Internal Medicine, Hospital of Sagunto, University of Valencia, Spain.
Blood Press Monit. 2001 Feb;6(1):27-32. doi: 10.1097/00126097-200102000-00005.
The objective of the present study was to analyze the influence of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme on ambulatory blood pressure values and circadian variability in untreated patients with hypertension.
Ninety-nine essential hypertensive patients, less than 50 years old (mean age 39.5+/-7.0 years), previously untreated with antihypertensive drugs were included. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed with a Spacelabs (90202 and 90207) monitor, during a regular working day in unrestricted ambulatory conditions. The I/D polymorphism of the ACE was determined by PCR.
The distributions of genotypes were in Hardy-Weinberg equilibrium: I=17 (17%), ID=41 (41.5%), DD=41 (41.5%). No significant differences were present among the groups in terms of age, sex, and biochemical and lipid profiles. The average of 24-h ambulatory blood pressure was slightly higher in patients with the DD genotype as compared with patients with the II and ID genotypes. This was the result of higher nighttime blood pressure values, because no differences in blood pressure were observed during daytime. The systolic blood pressure (SBP) day:night ratio, as an estimate of circadian variability, was significantly lower in subjects homozygous for the D allele than it was in patients carrying the I allele (1.13+/-0.09 vs. 1.17+/-0.08, P=0.014). The subjects in the lowest tertile of the SBP day:night ratio, exhibited a higher frequency of the D allele when compared with those in the middle tertile (0.74 vs. 0.59, P<0.05) or with those in the highest tertile (0.74 vs. 0.54, P<0.01). By using two-way ANOVA with repeated measures, significant differences in SBP variation over time were observed when comparing homozygous for the D allele with subjects carrying the I allele (F=2.11, P=0.002).
Among the genotypes of the I/D polymorphism, subjects carrying DD genotype showed a blunted decline of the physiological nocturnal fall of blood pressure that was significant for SBP.
本研究旨在分析血管紧张素转换酶插入/缺失（I/D）多态性对未经治疗的高血压患者动态血压值及昼夜变异性的影响。
纳入99例年龄小于50岁（平均年龄39.5±7.0岁）、此前未接受过降压药物治疗的原发性高血压患者。在正常工作日不受限制的动态条件下，使用太空实验室（90202和90207）监测仪进行24小时动态血压监测（ABPM）。通过聚合酶链反应（PCR）确定ACE的I/D多态性。
基因型分布符合哈迪-温伯格平衡：I = 17例（17%），ID = 41例（41.5%），DD = 41例（41.5%）。各组在年龄、性别、生化及血脂谱方面无显著差异。与II型和ID型基因型患者相比，DD型基因型患者的24小时动态血压平均值略高。这是夜间血压值较高的结果，因为白天血压未观察到差异。作为昼夜变异性的一项指标，D等位基因纯合子受试者的收缩压（SBP）昼夜比值显著低于携带I等位基因的患者（1.13±0.09 vs. 1.17±0.08，P = 0.014）。与处于SBP昼夜比值中间三分位数的受试者相比（0.74 vs. 0.59，P < 0.05），或与处于最高三分位数的受试者相比（0.74 vs. 0.54，P < 0.01），处于SBP昼夜比值最低三分位数的受试者D等位基因频率更高。通过使用重复测量的双向方差分析，比较D等位基因纯合子与携带I等位基因的受试者时，观察到SBP随时间变化存在显著差异（F = 2.11，P = 0.002）。
在I/D多态性的基因型中，携带DD基因型的受试者夜间血压生理性下降减弱，这在SBP方面具有显著性。
