THE ANGIOTENSINOGEN T235 VARIANT AND THE USE OF ANTIHYPERTENSIVE DRUGS IN A POPULATION-BASED COHORT

Variants of the angiotensinogen gene may increase the risk of developi ng arterial hypertension, but their effect on the use of antihypertens ive medication in the general population remains unclear. Thus, we det ermined T174M and M235T allele status and angiotensinogen plasma level s in a cross-sectional sample of 634 middle-aged subjects (48.4% men) from the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Augsburg cohort study. We found no association between T174M allele status and angiotensinogen levels, blood pressure, or use of an tihypertensive drugs. In contrast, multivariate analysis revealed that individuals who carried at least one copy of the T235 allele (n=418) had higher systolic and diastolic pressures (P=.007 and .008, respecti vely) and were more likely to use an antihypertensive drug (1.6-foId r isk, P=.04) than homozygotes for the M235 allele (n=216). The likeliho od of taking two or more antihypertensive medications was 2.1-fold hig her in carriers of the T235 allele (P=.02). Overall, 22.5% of all anti hypertensive drugs taken appeared to be attributable to the excess ris k associated with this allele. These associations were replicated in M o previous surveys carried out on the same individuals over 10 years. Furthermore, the T235 allele was related to higher angiotensinogen pla sma levels [15.5+/-0.31 versus 16.5+/-0.15 (nmol/L)/L in homozygotes f or the M235 and T235 alleles, respectively; P<.01], which were also re lated to systolic pressure (P=.03) and more intensive antihypertensive medication (P=.03). We conclude that the angiotensinogen T235 allele accounts for a substantial proportion of antihypertensive drug use in this middle-aged, population-based group of white subjects.