Association of angiotensin-converting enzyme DD genotype with blood pressure sensitivity to weight loss

Background Weight loss and sodium reduction are useful nonpharmacologic interventions in the management of hypertension. Salt sensitivity—the degree of blood pressure change in response to a change in sodium load—has been extensively explored. However, the determinants of the extent of blood pressure change after weight reduction have not been evaluated. Methods We studied the relationship of the angiotensin-converting enzyme insertion-deletion (ACE I/D) polymorphism to blood pressure change after weight loss in the Trial Of Nonpharmacologic interventions in the Elderly (TONE). We focused on the 86 overweight white hypertensive TONE participants who were randomized to weight loss only. Results A similar weight reduction was observed across all ACE genotypes, whereas a significantly greater decrease in blood pressure after weight loss was seen among participants with the DD genotype. In addition, DD participants had a higher probability of remaining normotensive for the duration of the trial. Conclusions The DD genotype may be associated with higher “weight sensitivity” in overweight white hypertensive persons, potentially through reduced activity of the renin-angiotensin and sympathetic systems after weight loss. (Am Heart J 2002;144:625-9.)