Celentano A, Mancini F P, Crivaro M, Palmieri V, De Stefano V, Ferrara L A, Di Minno G, de Simone G
Department of Clinical and Experimental Medicine, Federico II University Hospital, School of Medicine, Naples, Italy.
J Hypertens. 1998 Jul;16(7):985-91. doi: 10.1097/00004872-199816070-00012.
The angiotensin-converting enzyme gene insertion (I)/deletion (D) polymorphism might be involved in the development of several cardiovascular diseases, but its role in humans remains controversial.
To investigate the relation between the angiotensin converting enzyme gene polymorphism and extent of blood pressure elevation in arterial hypertension, taking into account the influence of cardiovascular risk factors.
We studied 171 patients (aged 49 +/- 9 years, 61 women) with abnormal clinic and 24 h ambulatory blood pressures, after a 3-week wash-out.
We found no significant difference in clinic and ambulatory blood pressures among homozygotic D (DD), heterozygotic D (ID) and homozygotic I (II) angiotensin converting enzyme genotypes and between homozygotic D (DD) and pooled heterozygotic D (ID) plus homozygotic I (II) (non-DD) angiotensin converting enzyme genotypes. At least one additional cardiovascular risk factor (smoking, hypercholesterolaemia or diabetes) was present for 103 patients (33 DD and 70 non-DD). Non-DD subjects (n = 43) without additional cardiovascular risk factors exhibited lower values of 24 h, daytime systolic and pulse blood pressures than did members of all other groups (all P < 0.04). In the presence of risk factors, DD and non-DD subjects exhibited similar systolic and pulse ambulatory blood pressures, in that we found higher values in non-DD genotype subjects with risk factors than we did for non-DD subjects without additional risk factors. In multivariate analysis, the combination of non-DD genotype and absence of cardiovascular risk factors was associated with the lowest values of systolic and pulse blood pressures.
Angiotensin converting enzyme insertion allele appears clustered with lower ambulatory systolic and pulse blood pressures in hypertensive patients when the potential interference of additional cardiovascular risk factors is eliminated. A high prevalence of cardiovascular risk factors in population studies might blunt a possible biological association of blood pressure with DD genotype by contributing to raising of blood pressures also in subjects with non-DD genotypes.
血管紧张素转换酶基因插入（I）/缺失（D）多态性可能与多种心血管疾病的发生有关，但其在人类中的作用仍存在争议。
考虑心血管危险因素的影响，研究血管紧张素转换酶基因多态性与动脉高血压患者血压升高程度之间的关系。
在3周的洗脱期后，我们研究了171例临床和24小时动态血压异常的患者（年龄49±9岁，女性61例）。
我们发现纯合子D（DD）、杂合子D（ID）和纯合子I（II）血管紧张素转换酶基因型之间以及纯合子D（DD）与合并的杂合子D（ID）加纯合子I（II）（非DD）血管紧张素转换酶基因型之间的临床和动态血压无显著差异。103例患者（33例DD和70例非DD）存在至少一种其他心血管危险因素（吸烟、高胆固醇血症或糖尿病）。无其他心血管危险因素的非DD受试者（n = 43）的24小时、日间收缩压和脉压值低于所有其他组（所有P < 0.04）。在存在危险因素的情况下，DD和非DD受试者的收缩压和动态脉压相似，因为我们发现有危险因素的非DD基因型受试者的值高于无其他危险因素的非DD受试者。在多变量分析中，非DD基因型和无心血管危险因素的组合与收缩压和脉压的最低值相关。
当消除其他心血管危险因素的潜在干扰时，血管紧张素转换酶插入等位基因在高血压患者中似乎与较低的动态收缩压和脉压聚集在一起。人群研究中心血管危险因素的高患病率可能会通过导致非DD基因型受试者血压升高而掩盖血压与DD基因型之间可能的生物学关联。
