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document
Impact of angiotensin-converting enzyme gene polymorphism on neurohormonal responses to high- versus low-dose enalapril in advanced heart failure . BACKGROUND The impact of angiotensin-converting enzyme ( ACE ) gene polymorphism on neurohormonal dose response to ACE inhibitor therapy is unclear . METHODS ACE Insertion ( I ) or Deletion ( D ) genotype was determined in 74 patients with chronic heart failure who were randomly assigned to receive either high-dose or low-dose enalapril over a period of 6 months . Monthly pre-enalapril and post-enalapril neurohormone levels ( serum ACE activity ( sACE ) , plasma angiotensin II ( A-II ) , plasma renin activity ( PRA ) , and serum aldosterone ( ALDO ) were compared between genotype subgroups and between patients who received high- or low-dose enalapril within each genotype subgroup . RESULTS At baseline , predose/postdose sACE and postdose PRA were significantly higher in the DD genotype . At 6-month follow-up , postdose sACE was reduced in a dose-dependent fashion in all three genotypes ( P < .05 ) . However , predose and postdose ALDO and A-II levels did not differ between each genotype subgroup at baseline or by enalapril dose within each genotype subgroup . ALDO escape and A-II reactivation were not affected by ACE genotype or enalapril dosage . CONCLUSIONS Predose sACE were consistently higher in the DD genotype when compared with ID or II subgroups . Despite a dose-dependent suppression of sACE , there were no observed statistically significant differences in ALDO and A-II suppression or escape with escalating doses of enalapril within each subgroup .
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Intervention_Pharmacological
ACE
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Intervention_Pharmacological
either high-dose or low-dose enalapril over a period of 6 months
19397
Intervention_Pharmacological
enalapril
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Outcome_Physical
neurohormonal responses
19399
Outcome_Physical
pre-enalapril and post-enalapril neurohormone levels ( serum ACE activity ( sACE )
19400
Outcome_Physical
plasma angiotensin II ( A-II ) , plasma renin activity ( PRA )
19401
Outcome_Physical
serum aldosterone ( ALDO
19402
Outcome_Physical
predose/postdose sACE and postdose PRA
19403
Outcome_Physical
postdose sACE
19404
Outcome_Physical
predose and postdose ALDO
19405
Outcome_Physical
A-II levels
19406
Outcome_Physical
ALDO escape
19407
Outcome_Physical
A-II reactivation
19408
Outcome_Physical
Predose sACE
19409
Outcome_Physical
suppression of sACE
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Outcome_Physical
ALDO
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Outcome_Physical
A-II suppression
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Participant_Condition
advanced heart failure .
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Participant_Condition
74 patients
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Participant_Condition
chronic heart failure