INFLUENCE OF CARDIOVASCULAR RISK-FACTORS ON RELATION BETWEEN ANGIOTENSIN-CONVERTING ENZYME-GENE POLYMORPHISM AND BLOOD-PRESSURE IN ARTERIAL-HYPERTENSION

Background The angiotensin-converting enzyme gene insertion (I)/deleti on (D) polymorphism might be involved in the development of several ca rdiovascular diseases, but its role in humans remains controversial. O bjective To investigate the relation between the angiotensin convertin g enzyme gene polymorphism and extent of blood pressure elevation in a rterial hypertension, taking into account the influence of cardiovascu lar risk factors, Methods 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 Results We found no significant difference in clinic and ambulatory blood pressures among homozygotic D (DD), hetero zygotic D (ID) and homozygotic I (II) angiotensin converting enzyme ge notypes and between homozygotic D (DD) and pooled heterozygotic D (ID) plus homozygotic I (II) (non-DD) angiotensin converting enzyme genoty pes, At least one additional cardiovascular risk factor (smoking, hype rcholesterolaemia or diabetes) was present for 103 patients (33 DD and 70 non-DD), Non-DD subjects (n = 43) without additional cardiovascula r risk factors exhibited lower values of 24 h, daytime systolic and pu lse blood pressures than did members of all other groups tall P < 0.04 ), In the presence of risk factors, DD and non-DD subjects exhibited s imilar systolic and pulse ambulatory blood pressures, in that we found higher values in non-DD genotype subjects with risk factors than we d id for non-DD subjects without additional risk factors, In multivariat e analysis, the combination of non-DD genotype and absence of cardiova scular risk factors was associated with the lowest values of systolic and pulse blood pressures, Conclusions Angiotensin converting enzyme i nsertion allele appears clustered with lower ambulatory systolic and p ulse blood pressures in hypertensive patients when the potential inter ference of additional cardiovascular risk factors is eliminated. A hig h prevalence of cardiovascular risk factors in population studies migh t blunt a possible biological association of blood pressure with DD ge notype by contributing to raising of blood pressures also in subjects with non-DD genotypes. I Hypertens 16:985-991 (C) 1998 Lippincott-Rave n Publishers.