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Abstract

Epidemiologic data suggest that hypertensive cardiac hypertrophy and insulin resistance are important predictors of cardiovascular morbidity and mortality. To investigate the possible relationship among ACE-gene polymorphism, insulin resistance and cardiac mass in a group of never treated hypertensive patients. Two hundred and thirty (133M, 97F; age=45.4+5.4 years) hypertensive never treated outpatients were enrolled. We evaluated clinic and ambulatory blood pressure, echocardiographic left ventricular mass indexed by body surface area and height2.7, fasting glucose and insulin levels. Insulin resistance was calculated using the homeostasis model assessment (HOMA). ACE genotypes were detected by double PCR, and ACE activity by colorimetric kit. No significant differences were observed in age, body mass index, blood pressure and glucose among the three ACE genotypes (DD, ID, II). Instead, fasting insulin (μU/mL) and HOMA were significantly (p<0.0001) higher in DD genotype (16.4+4.1; 3.7+1.0) than ID (9.6+3.7; 2.1+0.8) and II (8.0+3.0; 1.8+0.7) groups. Similarly, the cardiac mass was significantly (p<0.0001) increased in DD patients (143.1+31.1 g/m2, and 65.9+31.1 g/m2.7) when compared with ID (126.8+25.8 g/m2, and 58.3+12.5 g/m2.7) and II (115.7+22.8 g/m2, and 52.0+11.1 g/m2.7) groups. However, the polymorphism of the ACE-gene affects cardiac mass only in males, suggesting a gender effect. Moreover, we detected a significant linear relationship (p<0.0001) between ACE activity and HOMA (r=0.678), and HOMA and cardiac mass (r=0.620). The final model for cardiac mass included only HOMA (38.4%) and blood pressure (5.1%). In conclusion, our data suggest that insulin resistance is a powerful independent determinant of left ventricular mass in hypertensive DD patients.

insulin resistance, cardiac hypertrophy, ACE-gene polymorphism
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© American Journal of Hypertension, Ltd. 2001
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