Influence of the Angiotensin II Type 1 Receptor Gene Polymorphism on the Effects of Perindopril and Nitrendipine on Arterial Stiffness in Hypertensive Individuals

Abstract

Angiotensin-converting enzyme inhibitors improve arterial stiffness independently of blood pressure reduction. Since we have recently shown that in hypertensive individuals the A ¹¹⁶⁶ C polymorphism of the angiotensin II type 1 receptor (AT ₁ -R) is an independent determinant of aortic stiffness, we designed the present study to assess the influence of this polymorphism on the changes of aortic stiffness after chronic treatment with the angiotensin-converting enzyme inhibitor perindopril and the calcium channel blocker nitrendipine. Forty perindopril- and 42 nitrendipine-treated hypertensive individuals were studied. We evaluated aortic stiffness by measuring the carotid-femoral pulse wave velocity. Carriers of the AT ₁ -R C allele showed higher baseline values of pulse wave velocity than AA homozygotes ( P <.05). In the perindopril group, a threefold greater reduction in pulse wave velocity was observed in carriers of the C allele than in AA homozygotes (−2.85±0.62 versus −0.94±0.32 m/s, respectively; P <.001), whereas in the nitrendipine group, pulse wave velocity decreased only in AA homozygotes and not in AT ₁ -R C carriers (−1.38±0.35 versus +0.04±0.60 m/s, respectively; P <.01). These results indicate that according to the AT ₁ -R A ¹¹⁶⁶ C genotype, an angiotensin-converting enzyme inhibitor and a calcium channel blocker affect pulse wave velocity in opposite ways. Since some evidence shows that increased pulse wave velocity may enhance cardiovascular risk, it might be useful for physicians to consider the AT ₁ -R genotype when prescribing an angiotensin-converting enzyme inhibitor or calcium channel blocker to a hypertensive individual.