Angiotensin converting enzyme DD genotype is associated with hypertensive crisis

Objective: The genetic background of hypertensive crisis is unknown. We examined the association of polymorphisms in genes involved in the renin-angiotensin-aldosterone-system with hypertensive crisis. Design: Population-based case-control study. Setting: Emergency department at a tertiary care university hospital. Patients: A total of 182 patients with essential hypertension who were admitted to an emergency department for treatment of hypertensive crisis and 182 age- and sex-matched healthy individuals. Interventions:None. Measurements: Analysis of polymorphisms in genes coding for angiotensinogen (AGT 704T-->C), angiotensin II receptor 1 (AGTR1 1166A-->C), renin (REN2646G-->A), renin-binding protein (RENBP61T-->C), alpha-adducin (ADD1 1378G-->T), beta-2-adrenergic receptor (ADRB2 46A-->G, 79C-->G), and angiotensin I converting enzyme (ACE I/D) was performed by polymerase chain reaction and restriction fragment length polymorphism analysis. Main Results: Among patients, the ACE I/D polymorphism showed a deviation from Hardy-Weinberg equilibrium (p = .01). In controls, all polymorphisms were in the Hardy-Weinberg equilibrium. The frequency of the DD genotype was increased in patients (n = 70, 38.5%) vs. controls (n = 51; 28.0%; p = .03; odds ratio, 1.61; 95% confidence interval, 1.03-2.50), which was due to the DD genotype in 40 male patients (44%) vs. 23 in male controls (25.3%; p = .004; odds ratio, 3.48; 95% confidence interval, 1.47-8.30). There were no differences in genotype distributions among other polymorphisms. Conclusion: We demonstrate a possible association of the ACE DD genotype with hypertensive crisis in men.