The Renin-Angiotensin System Gene Polymorphism and Left Ventricular Hypertrophy

  • Laurence Tiret
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 432)


Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular morbidity and mortality, independently of blood pressure. This has been clearly demonstrated in the Framingham Study. On the other hand, inhibitors of angiotensin-converting enzyme (ACE) have been shown to have a beneficial effect on LVH. In the SOLVD trial, treatment by ACE-inhibitors was associated with a reduction of the incidence of myocardial infarction (MI) and unstable angina and of cardiovascular mortality in patients with a low ejection fraction. In the SAVE trial including post-MI patients, treatment by ACE-inhibitors was associated with a decrease of mortality and incidence of re-infarction. These results, together with the fact that angiotensin II is implicated in the modulation of cardiac growth, suggest that polymorphisms of the renin angiotensin system could play a role in the determination of left ventricular mass (LVM) and the genetic predisposition of LVH.


Left Ventricular Hypertrophy Left Ventricular Mass Hypertrophic Cardiomyopathy Renin Angiotensin System Idiopathic Dilate Cardiomyopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Iwai N, Ohmichi N, Nakamura Y, Kinoshita M. DD genotype of the angiotensin-converting enzyme gene is a risk factor for left ventricular hypertrophy. Circulation. 1994;90:2622–2628.PubMedCrossRefGoogle Scholar
  2. 2.
    Kupari M, Perola M, Koskinen P, Virolainen J, Karhunen P. Left ventricular size, mass and function in relation to angiotensin-converting enzyme gene polymorphism in humans. Am J Physiol. 1994;267:H1107–H1111.PubMedGoogle Scholar
  3. 3.
    Prasad N, O’Kane KPJ, Johnstone HA, Wheeldon NM, McMahon AD, Webb DJ, MacDonald TM. The relationship between blood pressure and left ventricular mass in essential hypertension is observed only in the presence of the angiotensin-converting enzyme gene deletion allele. Q J Med. 1994;87:659–662.Google Scholar
  4. 4.
    Schunkert H, Hense HW, Holmer SR, Stender M, Perz S, Keil U, Lorell BH, Riegger GAJ. Association between a deletion polymorphism of the angiotensin-converting-enzyme gene and left ventricular hypertrophy. N Engl J Med. 1994;330:1634–1638.PubMedCrossRefGoogle Scholar
  5. 5.
    West M, Summers K, Burstow D, Wong K, Huggard P. Renin and angiotensin-converting enzyme genotypes in patients with essential hypertension and left ventricular hypertrophy. Clin Exp Pharm Physiol. 1994;21:207–210.CrossRefGoogle Scholar
  6. 6.
    Gharavi A, Lipkowitz M, Diamond J, Jhang J, Phillips R. Deletion polymorphism of the angiotensin-converting enzyme gene is independently associated with left ventricular mass and geometric remodeling in systemic hypertension. Am J Cardiol. 1996;77:1315–1319.PubMedCrossRefGoogle Scholar
  7. 7.
    Lindpaintner K, Lee M, Larson MG, Rao VS, Pfeffer MA, Ordovas JM, Schaefer EJ, Wilson AF, Wilson PWF, Vasan RS, Myers RH, Levy D. Absence of association or genetic linkage between the angiotensin-converting-enzyme gene and left ventricular mass. N Engl J Med. 1996;334:1023–1028.PubMedCrossRefGoogle Scholar
  8. 8.
    Wong K, Summers K, Burstow D, West M. Genetic variants of proteins from the renin angiotensin system are associated with pressure load cardiac hypertrophy. Clin Exp Pharm Physiol. 1996;23:587–590.CrossRefGoogle Scholar
  9. 9.
    Busjahn A, Knoblauch H, Knoblauch M, Bohlender J, Menz M, Faulhaber H, Becker A, Schuster H, Luft F. Angiotensin-Converting enzyme and angiotensinogen gene polymorphisms, plasma levels, cardiac dimensions. A twin study. Hypertension. 1997;29[part 2]: 165–170.PubMedCrossRefGoogle Scholar
  10. 10.
    Ohmichi N, Iwai N, Nakamura Y, Izumi M, Kinoshita M. The genotype of the angiotensin-converting enzyme gene and global left ventricular dysfunction after myocardial infarction. Am J Cardiol. 1995;76:326–329.PubMedCrossRefGoogle Scholar
  11. 11.
    Pinto Y, van Gilst W, Kingma J, Schunkert H. Deletion-type allele of the angiotensin-converting enzyme gene is associated with progressive ventricular dilation after anterior myocardial infarction. J Am Coll Cardiol. 1995;25:1622–1626.PubMedCrossRefGoogle Scholar
  12. 12.
    Ohmichi N, Iwai N, Maeda K, Shimoike H, Nakamura Y, Izumi M, Sugimoto Y, Kinoshita M. Genetic basis of left ventricular remodeling after myocardial infarction. Int J Cardiol. 1996;53:265–272.PubMedCrossRefGoogle Scholar
  13. 13.
    Marian AJ, Yu Q, Workman R, Greve G, Roberts R. Angiotensin-converting enzyme polymorphism in hypertrophic cardiomyopathy and sudden cardiac death. Lancet. 1993;342:1085–1086.PubMedCrossRefGoogle Scholar
  14. 14.
    Lechin M, Quinones M, Omran A, Hill R, Yu Q, Rakowski H, Wigle D, Liew C, Sole M, Roberts R, Marian A. Angiotensin-converting enzyme genotypes and left ventricular hypertrophy in patients with hypertrophic cardiomyopathy. Circulation. 1995;92:1808–1812.PubMedCrossRefGoogle Scholar
  15. 15.
    Yoneya K, Okamoto H, Machida M, Onozuka H, Noguchi M, Mikami T, Kawaguchi H, Murakami M, Uede T, Kitabatake A. Angiotensin-converting enzyme gene polymorphism in Japanese patients with hypertrophic cardiomyopathy. Am Heart J. 1995;130:1089–1093.PubMedCrossRefGoogle Scholar
  16. 16.
    Pfeufer A, Osterziel K, Urata H, Borck G, Schuster H, Wienker T, Dietz R, Luft F. Angiotensin-converting enzyme and heart chymase gene polymorphisms in hypertrophic cardiomyopathy. Am J Cardiol. 1996;78: 362–364.PubMedCrossRefGoogle Scholar
  17. 17.
    Raynolds MV, Bristow MR, Bush EW, Abraham WT, Lowes BD, Zisman LS, Taft CS, Perryman MB. Angiotensin-converting enzyme DD genotype in patients with ischaemic or idiopathic dilated cardiomyopathy. Lancet. 1993;342:1073–1075.PubMedCrossRefGoogle Scholar
  18. 18.
    Montgomery H, Keeling P, Goldman J, Humphries S, Talmud P, McKenna W. Lack of association between the insertion/deletion polymorphism of the angiotensin-converting enzyme gene and idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 1995;25:1627–1631.PubMedCrossRefGoogle Scholar
  19. 19.
    Andersson B, Sylven C. The DD genotype of the angiotensin-converting enzyme gene is associated with increased mortality in idiopathic heart failure. J Am Coll Cardiol. 1996;28:162–167.PubMedCrossRefGoogle Scholar
  20. 20.
    Sanderson J, Young R, Yu C, Chan S, Critchley J, Woo K. Lack of association between insertion/deletion polymorphism of the angiotensin-converting enzyme gene and end-stage heart failure due to ischemic or idiopathic dilated cardiomyopathy in the Chinese. Am J Cardiol. 1996;77:1008–1010.PubMedCrossRefGoogle Scholar
  21. 21.
    Montgomery H, Clarkson P, Dollery C, Prasad K, Losi M, Statters D, Jubb M, McEwan J, Humphries S, McKenna W. D polymorphism of the angiotensin converting enzyme gene is strongly associated with the development of physiological left ventricular hypertrophy. J Am Coll Cardiol. 1996;27(suppl A):244A.Google Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Laurence Tiret
    • 1
  1. 1.INSERMParisFrance

Personalised recommendations