DELETION POLYMORPHISM OF THE ANGIOTENSIN-CONVERTING ENZYME GENE IS INDEPENDENTLY ASSOCIATED WITH LEFT-VENTRICULAR MASS AND GEOMETRIC REMODELING IN SYSTEMIC HYPERTENSION

An insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with myocardial infarction, cardiomyo pathy, and left ventricular (LV) hypertrophy. LV mass and geometry are related to cardiovascular morbidity and mortality. Two-dimensional di rected M-mode echocardiograms and 24-hour ambulatory blood pressure mo nitoring were performed in 67 hypertensive subjects. Echocardiographic measurements were assessed in blinded fashion. LV mass index and rela tive wall thickness were calculated. ACE genotypes were determined by polymerase chain reaction amplification of deoxyribonucleic acid prepa red from leukocytes, using primers that encompass the polymorphic segm ent. Systolic ambulatory blood pressure was higher in subjects with th e II genotype. All other patient characteristics were similar across g enotype groups. After adjustment for other covariables, the DD and ID genotypes were associated with significantly higher LV mass index than was the II genotype. Adjusted relative wall thickness was also higher in subjects with the DD genotype than in subjects with the ID and II genotypes. On multiple regression analysis, systolic ambulatory blood pressure, gender, body mass index, and the ACE genotype were each inde pendently related to LV mass index (R(2)=0.53). Systolic ambulatory bl ood pressure, race, and ACE genotype were each independently related t o relative wall thickness (R(2)=0.34). The ACE genotype explained an a dditional 3% and 4% of the variations of LV mass index and relative wa ll thickness, respectively. In conclusion, ACE polymorphism accounted for a small but statistically significant proportion of the variation in LV mass and geometry in our hypertensive subjects.