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(Circulation. 1999;100:e85-e86.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Renin-Angiotensin System and Blood Pressure

A.H.J. Danser, PhD

Department of Pharmacology Erasmus University Rotterdam, Rotterdam, The Netherlands

H. Schunkert, MD, PhD

Klinik und Poliklinik für Innere Medizin II University of Regensburg, Regensburg, Germany

	Introduction

 
To the Editor:

With great interest, we read the articles by O'Donnell et al¹ and Fornage et al² in the May 12, 1998, issue of Circulation. Their data suggest genetic linkage between the ACE gene and blood pressure in men but not in women. Likewise, we previously described associations of ACE with arterial blood pressure³ and with ECG evidence of left ventricular hypertrophy⁴ only in men. It may be worthwhile, therefore, to point to another apparent sexual dimorphism of the renin-angiotensin system. In men, renin and prorenin are 30% and 50% higher, respectively, than in women,⁵ a difference that may diminish during menopause. Renin is the second major enzyme of this system and is responsible for generation of angiotensin I (the substrate of ACE). It may thus be speculated that men with genetically elevated ACE levels (DD genotype) are confronted with higher angiotensin I levels and, thereby, may have a higher chance to present with complex phenotypes. The stoichiometry of ACE and renin was also probed by a recent transgenic rat model with high levels of human ACE transgene expression in the heart.⁶ Although this transgenic animal has almost no apparent phenotype under baseline conditions, abdominal aortic banding and subsequently high renin levels resulted in enhanced left ventricular hypertrophy. Similarly, Montgomery et al⁷ found a much more marked increase in left ventricular mass in response to intense physical training in males with the ACE D allele than in II homozygotes, whereas left ventricular mass was similar in the genotype . . . [Full Text of this Article]