Cruz-González Ignacio, Corral Esther, Sánchez-Ledesma María, Sánchez-Rodríguez Angel, Martín-Luengo Cándido, González-Sarmiento Rogelio
Cardiology Department, University Hospital of Salamanca, Salamanca, Spain.
BMC Cardiovasc Disord. 2009 Aug 4;9:35. doi: 10.1186/1471-2261-9-35.
It is estimated that 5% of the hypertensive patients are resistant to conventional antihypertensive therapy. Polymorphisms in the endothelial nitric oxide synthase (NOS3) gene have been associated with high blood pressure levels, but not with resistant hypertension. The aim of the present study was to investigate if the -786T>C and G894T (Glu298Asp) polymorphisms of the NOS3 gene were associated with resistant hypertension.
A prospective case-control observational study was performed. From a series of 950 consecutive patients followed up during 42 months, 48 patients with resistant hypertension were detected. 232 patients with controlled high blood pressure were also included.
No differences were observed in the distribution of G894T (Glu298Asp) NOS3 genotypes between the resistant hypertension group and the controlled hypertension patients. However, genotype -786CC was more frequent in the group of patients with resistant hypertension (33.3%) than in the group of patients with controlled high blood pressure (17.7%) (p 0.03). Furthermore carriers of allele T (-786TC and -786TT) were more frequent in patients with controlled hypertension (82.3%) than those with resistant hypertension (66.7%) (Multivariate analysis; RR 2.09; 95% CI 1.03-4.24; p 0.004).
Our results indicate that genotype -786CC of the NOS3 gene increase the susceptibility to suffer resistant hypertension, which suggest that resistance to conventional therapy could be determined at the endothelial level.
据估计，5%的高血压患者对传统抗高血压治疗有抵抗性。内皮型一氧化氮合酶（NOS3）基因多态性与高血压水平相关，但与顽固性高血压无关。本研究的目的是调查NOS3基因的-786T>C和G894T（Glu298Asp）多态性是否与顽固性高血压相关。
进行了一项前瞻性病例对照观察研究。在连续随访42个月的950例患者中，检测到48例顽固性高血压患者。还纳入了232例血压得到控制的高血压患者。
在顽固性高血压组和血压得到控制的高血压患者之间，未观察到G894T（Glu298Asp）NOS3基因型分布的差异。然而，-786CC基因型在顽固性高血压患者组中（33.3%）比在血压得到控制的高血压患者组中（17.7%）更常见（p = 0.03）。此外，等位基因T（-786TC和-786TT）携带者在血压得到控制的高血压患者中（82.3%）比在顽固性高血压患者中（66.7%）更常见（多变量分析；RR = 2.09；95% CI 1.03 - 4.24；p = 0.004）。
我们的结果表明，NOS3基因的-786CC基因型增加了患顽固性高血压的易感性，这表明对传统治疗的抵抗性可能在内皮水平上就已确定。
