Cardiovascular risk factors, angiotensin-converting enzyme gene I/D polymorphism, and left ventricular mass in systemic hypertension

We investigated the influence of major cardiovascular risk factors (smoking , hypercholesterolemia, diabetes mellitus) on the association between angio tensin-converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphism and echocardiographic left ventricular mass in 225 patients with sustained hypertension, assessed by ambulatory blood pressure monitoring, When the s tudy population was analyzed as a whole, the 3 ACE genotypes did not differ in left ventricular mass (II, 47 g/m(2.7); ID, 49 g/m(2.7); DD, 51 g/m(2.7 ); p = NS). No difference was found in subjects (n = 135) in whom at least 1 major cardiovascular risk factor was present (II, 51 g/m(2.7); ID, 51 g/m (2.7); DD: 52 g/m(2.7); p = NS). In contrast, in the absence of cardiovascu lar risk factors, DD subjects (n = 32) exhibited left. ventricular mass ind ex higher than non-DD (ID/II) subjects (n = 75; p <0.05). After controlling for age and sex, in the absence of cardiovascular risk factors, the risk o f left ventricular hypertrophy was 3.8-fold higher in DD than in non-DD pat ients (odds ratio 3.8; 95% confidence interval 1.2 to 12.1, p <0.02). We co nclude that in the present setting of patients with established sustained s ystemic hypertension, the absence of risk factors potentially affecting car diovascular adaptation allows for the detection of a positive association b etween homozygosity for the D allele of the ACE gene and left ventricular h ypertrophy. (C)1999 by Excerpta Medica, Inc.