Influence of ACE gene polymorphisms on antihypertensive efficacy, left ventricular mass and proteinuria in children undergoing ramipril monotherapy

Abstract

OBJECTIVEIt is unclear whether ACE gene polymorphisms influence the therapeutic outcome of a ACE‐inhibitor therapy. We therefore investigated the role of the ACE I/D polymorphism on 24‐hour blood pressure (ABPM), left ventricular mass index (LVMI) an proteinuria in children following ramipril monotherapy.METHODSSixty children (age 14.4±3.8 years) with various chronic nephropathies and hypertension received ramipril monotherapy (mean maximum dose 5.3±1.6 mg/m2). Their ACE I/D genotype was correlated to results of the 24‐h ABPM, LVMI and amount of proteinuria before and 6 months after treatment.RESULTSMean SDS blood pressure (BP) significantly dropped within 6 months (2.2±1.7 vs. 0.4±1.1 after 6 months, P<0.0001). This effect remains when patients are stratified according to the ACE II or DD genotype (mean SDS‐BP; II: 3.3±0.5 vs. 1.2±0.3, P=0.019; DD: 2.3±0.5 vs. 0.3±0.4, P=0.013). LVMI did not significantly differ before and following initiation of ramipril treatment and a stratification by ACE genotype did not reveal a difference either. However, proteinuria remained significantly higher in patients with the DD genotype.CONCLUSIONSRamipril is an efficacious antihypertensive therapy in children. Whereas the ACE genotype does not have an impact on the LVMI development, the DD‐allele seems to be negatively associated with the antiproteinuric effect of ramipril.