Renin Angiotensin System Blockage Associates with Insertion/Deletion Polymorphism of Angiotensin-Converting Enzyme in Patients with Hypertensive Emergency

Abstract

Hypertensive crisis (HC) stands out as a form of acute elevation of blood pressure (BP). It can manifest itself as hypertensive emergency (HE) or hypertensive urgency (HU), which is usually accompanied with levels of diastolic BP ≥120 mmHg. Angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism may influence manifestations of HC. Thus, this study evaluated the influence of ACE I/D polymorphism in individuals with HC. A total of 187 patients admitted with HC (HU [n=69] and HE [n=118]) and 75 normotensive individuals were included in the study. Peripheral blood was drawn for a biochemical and genetic analysis of the ACE I/D polymorphism by Polymerase Chain Reaction. HC group showed higher systolic BP, body mass index (BMI), glycemia, creatinine, and lower high-density lipoprotein (HDL) cholesterol compared with normotensive individuals. The use of renin-angiotensin system (RAS) blockers was more frequent in the HU group than in the HE group (p=0.020). The II genotype was more predominant in normotensive and HU individuals than among HE individuals (18.7%, 11.6%, and 2.5%, respectively; p=0.004). Higher BMI and glycemia were associated with HC in the logistic regression model. ACE II genotype (odds ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.51) and HDL cholesterol were protective for the development of HE. ACE II genotype was present in the HU group, compared with the HE group (OR 0.18; 95% CI 0.04-0.88). This study shows an association between the low prevalence of ACE I/D polymorphism II genotype and a greater occurrence of HE in Brazilian individuals. The lower blockage of RAS, which was detected in the HE group, may interact with the low frequency of II genotype, conferring an increased risk for HE.

Genetic Determinants of Dyslipidemia in African-Based Populations: A Systematic Review

“…Established link has already been demonstrated between ACE I/D polymorphism and the risk of myocardial infarction and cardiovascular events (Hamelin et al, 2011;Vaisi-Raygani et al, 2010;Zintzaras et al, 2008), microalbuminuria (Pontremoli et al, 2000;Staessen et al, 1997), left ventricular hypertrophy (Perticone et al, 1997), thoracic aortic aneurysm in patients with bicuspid or tricuspid aortic valves (Foffa et al, 2012), pregnancy hypertensive disorders (Chen et al, 2012;Reshetnikiv et al, 2015), and hypertensive emergency (Vilela-Martin et al, 2013). Yet, the findings of this study are in line with the above-mentioned investigations.…”

Angiotensin-converting enzyme insertion/deletion polymorphism, 24-h blood pressure profile and left ventricular hypertrophy in hypertensive individuals: a cross-sectional study

“…Recently, another investigation demonstrated individuals presented with emergency hypertensive (HE) characterized by TOD had a lower frequency of the II genotype and less use of RAS blockers when compared with the hypertensive urgency group, characterized as no TOD. Thus, the risk of an individual having HE was increased in the presence of these two conditions (low frequency of the II genotype and less use of RAS blockers) [ 18 ]. On the other hand, one study demonstrated the effect of ramipril in inflammatory response in patients undergoing coronary artery bypass grafts without the ACE I/D gene polymorphism influence [ 53 ].…”

“…The ACE I/D polymorphism is linked to risk for myocardial infarction and cardiovascular events [ 6 – 9 ], LVH [ 10 – 12 ], microalbuminuria [ 11 , 13 , 14 ], thoracic aortic aneurysm in patients with bicuspid or tricuspid aortic valves [ 15 ], pregnancy hypertensive disorders [ 16 , 17 ], and hypertensive emergency [ 18 ]. Moreover, this polymorphism is related to inter-individual differences in BP response, for example, a low dose of the hydrochlorothiazide diuretic produced greater BP reductions in men with the DD genotype and women with the II genotype [ 19 ].…”

Estudo da influência do polimorfismo da enzima conversora de angiotensina em casos de hipertensão

“…A pressão arterial média dos participantes foi diferente entre os estudos incluídos. A média de PAS / PAD foi mais alta em um estudo realizado no Brasil relatando um nível de PA de 201,0 (± 29,3) / 128,1 (± 18,0) (VILELA- MARTIN et al, 2013). E a média de PAS/PAD foi mais baixa em um estudo indiano que relatou um nível de PA de 145,5 (± 14,05) / 93,6 (± 8,09) (SRIVASTAVA et al, 2012).…”