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Impact of renin-angiotensin-aldosterone system genes on the treatment response of patients with hypertension and metabolic syndrome

Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece, hmilioni{at}cc.uoi.gr

Michael S Kostapanos

Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece

Konstantinos Vakalis

Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece

Ioanna Theodorou

Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece

Ioanna Bouba

Laboratory of Human Reproductive Genetics, School of Medicine, University of Ioannina, Ioannina, Greece

Rigas Kalaitzidis

Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece

Ioannis Georgiou

Laboratory of Human Reproductive Genetics, School of Medicine, University of Ioannina, Ioannina, Greece

Moses S Elisaf

Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece

Kostas C Siamopoulos

Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece

Objective. To evaluate the influence of clinical, biochemical and genetic markers on the response to antihypertensive treatment in patients with essential hypertension and the metabolic syndrome (MetS).

Methods. Measurements of anthropometric indices, blood pressure (BP), and metabolic parameters were obtained from the medical records of 132 (77 women) newly diagnosed, untreated hypertensive patients. Renin-angiotensin-aldosterone system (RAAS) genes polymorphisms (including ACE I/D, angiotensinogen M235T, angiotensin II type 1 receptor [AT₁-receptor] A1166C) were determined. Response to treatment was defined as BP less than 140/90 mmHg.

Results. Patients with MetS (n=60) had higher systolic BP and pulse pressure and a more atherogenic lipid profile than patients without MetS.The frequencies of the ACE and the AT₁-receptor gene polymorphisms were similar between patients with and without MetS. Response to treatment was positively associated with pulse pressure, and the presence of the C allele as well as the AC genotype of the AT₁-receptor gene and inversely with age after adjustment for confounding factors.

Conclusions. RAAS genes distribution does not differ between hypertensive patients with and without the MetS. Higher baseline pulse pressure levels, the presence of the C allele and/or the AC genotype may be in favour of a better response to structured antihypertensive treatment in patients with MetS. However, these findings need to be evaluated in future studies.

Key Words: essential hypertension • metabolic syndrome • renin-angiotensin-aldosterone system genes • response to treatment

Journal of Renin-Angiotensin-Aldosterone System, Vol. 8, No. 4, 181-189 (2007)
DOI: 10.3317/jraas.2007.027


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