Related Terms

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Background

• Angiotensin converting enzyme (ACE) is a protein in the body that creates the molecule angiotensin II. Angiotensin II increases blood pressure by causing blood vessels to constrict and by causing the kidneys to retain water. ACE inhibitors are a type of drug commonly used to treat high blood pressure (hypertension). By decreasing the activity of ACE, the levels of angiotensin II are reduced, and blood pressure is lowered. Some patients do not respond to these drugs because of variations in the genes that code for the ACE protein.
• Genes are present in all human cells. They are composed of deoxyribonucleic acid (DNA). The genes provide instructions for making proteins, which are responsible for the structure and function of cells, tissues, and organs. While any two individuals share about 99.9% of the same genes, differences do exist (except in identical twins). These differences are called gene variants, or polymorphisms, and are caused by small changes in the DNA code of the genes. The small changes may be inherited from a parent or may occur as a random mutation in the gene.
• Polymorphisms in the gene that provides instructions for making the ACE protein can result in the production of more or less ACE protein. This may produce high blood pressure that does not respond well to treatment with ACE inhibitor medications. Examples of these medications include captopril, enalapril, and lisinopril. Some studies have also linked ACE polymorphisms to an increased risk of heart attack, kidney disease, and Alzheimer's disease. The mechanism underlying the effect of elevated levels of ACE protein and these disorders is poorly understood but may involve damage to blood vessels from uncontrolled high blood pressure.
• Polymorphisms in the ACE gene that result in higher levels of the ACE protein in the blood appear to occur in all races. However, the effect is not the same in all races. In Caucasians and Asians, the ACE polymorphism results in higher levels of protein in the blood, meaning that if these patients require treatment for high blood pressure, they will not respond to ACE inhibitors. However, African Americans may have the same gene variant, but it has no effect on blood protein levels in this population, and therefore, ACE inhibitors work in this population. The reason for this difference is unclear.

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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