Does the Angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism modify the response to ACE inhibitor therapy? - A systematic review

Madlaina Scharplatz, Milo A. Puhan, Johann Steurer, Annalisa Perna, Lucas M. Bachmann

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pharmacogenetic testing to individualize ACE inhibitor therapy remains controversial. We conducted a systematic review to assess the effect modification of the insertion/deletion (I/D) polymorphism of the ACE gene on any outcome in patients treated with ACE inhibitors for cardiovascular and/or renal disease. Methods: Our systematic review involved searching six electronic databases, then contacting the investigators (and pharmaceutical industry representatives) responsible for the creation of these databases. Two reviewers independently selected relevant randomized, placebocontrolled trials and abstracted from each study details on characteristics and quality. Results: Eleven studies met our inclusion criteria. Despite repeated efforts to contact authors, only four of the eleven studies provided sufficient data to quantify the effect modification by genotypes. We observed a trend towards better response to ACE inhibitors in Caucasian DD carriers compared to II carriers, in terms of blood pressure, proteinuria, glomerular filtration rate, ACE activity and progression to end-stage renal failure. Pooling of the results was inappropriate, due to heterogeneity in ethnicity, clinical domains and outcomes. Conclusions: Lack of sufficient genetic data from the reviewed studies precluded drawing any convincing conclusions. Better reporting of genetic data are needed to confirm our preliminary observations concerning better response to ACE inhibitors among Caucasian DD carriers as compared to II carriers.

Original languageEnglish (US)
Article number16
JournalCurrent Controlled Trials in Cardiovascular Medicine
Volume6
DOIs
StatePublished - Oct 24 2005
Externally publishedYes

Keywords

  • ACE I/D polymorphism
  • Angiotensin-converting enzyme
  • Pharmacogenetics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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