Internal Medicine Department, Hypertension Clinic-Hospital de Base, State Medical School of São José do Rio Preto (FAMERP), São Paulo, Brazil.
DNA Cell Biol. 2013 Sep;32(9):541-8. doi: 10.1089/dna.2012.1951. Epub 2013 Jul 19.
Hypertensive crisis (HC) stands out as a form of acute elevation of blood pressure (BP). It can manifest itself as hypertensive emergency (HE) or hypertensive urgency (HU), which is usually accompanied with levels of diastolic BP ≥120 mmHg. Angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism may influence manifestations of HC. Thus, this study evaluated the influence of ACE I/D polymorphism in individuals with HC. A total of 187 patients admitted with HC (HU [n=69] and HE [n=118]) and 75 normotensive individuals were included in the study. Peripheral blood was drawn for a biochemical and genetic analysis of the ACE I/D polymorphism by Polymerase Chain Reaction. HC group showed higher systolic BP, body mass index (BMI), glycemia, creatinine, and lower high-density lipoprotein (HDL) cholesterol compared with normotensive individuals. The use of renin-angiotensin system (RAS) blockers was more frequent in the HU group than in the HE group (p=0.020). The II genotype was more predominant in normotensive and HU individuals than among HE individuals (18.7%, 11.6%, and 2.5%, respectively; p=0.004). Higher BMI and glycemia were associated with HC in the logistic regression model. ACE II genotype (odds ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.51) and HDL cholesterol were protective for the development of HE. ACE II genotype was present in the HU group, compared with the HE group (OR 0.18; 95% CI 0.04-0.88). This study shows an association between the low prevalence of ACE I/D polymorphism II genotype and a greater occurrence of HE in Brazilian individuals. The lower blockage of RAS, which was detected in the HE group, may interact with the low frequency of II genotype, conferring an increased risk for HE.
高血压危象（HC）是一种血压急性升高的形式。它可以表现为高血压急症（HE）或高血压亚急症（HU），通常伴有舒张压≥120mmHg。血管紧张素转换酶（ACE）基因插入/缺失（I/D）多态性可能影响 HC 的表现。因此，本研究评估了 ACE I/D 多态性在 HC 个体中的影响。共纳入 187 例 HC 患者（HU[69 例]和 HE[118 例]）和 75 例血压正常个体。抽取外周血，通过聚合酶链反应进行 ACE I/D 多态性的生化和遗传分析。HC 组的收缩压、体重指数（BMI）、血糖、肌酐较高，高密度脂蛋白（HDL）胆固醇较低。与 HE 组相比，HU 组更常使用肾素-血管紧张素系统（RAS）阻滞剂（p=0.020）。II 基因型在血压正常和 HU 个体中比在 HE 个体中更为常见（18.7%、11.6%和 2.5%；p=0.004）。在逻辑回归模型中，较高的 BMI 和血糖与 HC 相关。ACE II 基因型（比值比[OR]0.14；95%置信区间[CI]0.04-0.51）和 HDL 胆固醇对 HE 的发生具有保护作用。与 HE 组相比，HU 组存在 ACE II 基因型（OR0.18；95%CI0.04-0.88）。本研究表明，巴西个体中 ACE I/D 多态性 II 基因型的低流行率与 HE 的发生率较高相关。HE 组中检测到的 RAS 阻断作用较低，可能与 II 基因型的低频率相互作用，使 HE 的风险增加。
