Insertion /deletion (I/D) polymorphism at the locus for angiotensin I-converting enzyme and parental history of myocardial infarction

Bøhn M, Berge KE, Bakken A, Erikssen J, Berg K. Insertion/deletion (I/D) polymorphism at the locus for angiotensin I-converting enzyme and parental history of myocardial infarction.
Clin Genet 1993: 44: 298–301. © Munksgaard, 1993
One hundred and eighty-one male and 48 female myocardial infarction (MI) survivors and 172 male and 194 female controls were studied with respect to a possible association between premature parental MI (before age 61 years in mothers and/or before age 56 years in fathers) and an insertion/deletion (I/D) polymorphism in the gene encoding angiotensin I-converting enzyme (ACE). In the total series, the frequency of premature parental MI was 14% in the DD (homozygotes for the deletion (D) allele) genotypic group, 10.6% in the ID (heterozygotes) genotypic group and 6.1% in the II (homozygotes for the insertion (I) allele) genotypic group. In all males (male MI survivors and male controls combined), and in the total series, there was a significant excess of DD individuals as compared to II individuals among those with a parental history of premature MI (odds ratio 3.1 (p = 0.03) and 3.1 (p = 0.009), respectively). The ACE polymorphism may be an important genetic marker of MI risk and contribute to clustering of premature MI in families.     

A prospective evaluation of the angiotensin-converting enzyme D/I polymorphism and left ventricular remodeling in the 'Healing and Early Afterload Reducing Therapy' study

The D/I (deletion, D, insertion, I) polymorphism of the angiotensin-converting enzyme (ACE) gene has been extensively studied for its association with a number of cardiovascular and other disease states. However, its potential association with differential clinical efficacy of ACE inhibitors (ACE-I) administered to patients who had suffered a myocardial infarction (MI), i.e. the prevention of left ventricular (LV) remodeling, has so far not been specifically studied. The aim of the study was to investigate whether the D/I polymorphism of the ACE gene is associated with the incidence of post-MI LV remodeling in patients drawn from the 'Healing and Early Afterload Reducing Therapy' (HEART) Study. The ACE D/I polymorphism was characterized by the polymerase chain reaction (PCR) in 265 subjects from the 'Healing and Early Afterload Reducing Therapy' Study, a double-blind, placebo-controlled trial with the objective of determining whether early or delayed administration of the ACE-I, ramipril, in patients with acute anterior wall MI would be optimal in reducing LV enlargement. Selected frequencies for the ACE D and I alleles were 0.59 and 0.41 (placebo-high dose group), 0.56 and 0.44 (low dose-low dose group), and, 0.60 and 0.40 (high dose-high dose group), respectively. All observed genotype frequencies were in Hardy-Weinberg equilibrium. There was no evidence for an association between genotype and outcome regarding LV size or function, nor with the initial blood pressure response after ACE-I administration (adjusted for covariates). Our data provide no evidence for an association of the ACE D/I polymorphism with the risk of LV remodeling post-MI in the presence of ACE-I therapy, and therefore do not suggest that differential clinical efficacy of ACE-inhibitors is related to this genetic marker.     

血管紧张素转化酶基因I/D多态性与脑梗死后抑郁相关

目的 探讨北京地区汉族人群血管紧张素转化酶(ACE)基因插入/缺失(I/D)多态性与脑梗死后抑郁(PCID)发病的关系.方法 用汉密尔顿抑郁量表评定664例脑梗死患者抑郁状态,用PCR方法检测患者ACE基因I/D多态性,分析基因多态性分布与脑梗死后抑郁发病的相关性.结果 脑梗死后抑郁患者组ACE基因I/I基因型频率和I等位基因频率(分别为0.388和0.549)显著高于脑梗死后非抑郁患者对照组(C)(分别为0.286和0.481,P＜0.05).结论 ACE基因I/D多态性与脑梗死后抑郁发病相关,ACE I/I基因型可能是脑梗死后抑郁发病的危险因素.     

Angiotensin converting enzyme gene polymorphism and cardiovascular morbidity and mortality: the Rotterdam Study

Background: Findings on the association between the insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene and cardiovascular morbidity and mortality have been inconsistent. Considering the possible interaction between this polymorphism and smoking, we evaluated the association between ACE I/D polymorphism and myocardial infarction (MI), mortality due to coronary heart disease (CHD), and cardiovascular disease (CVD).

Methods: The study was performed within the Rotterdam Study, a population based cohort study. The ACE I/D polymorphism was determined for 6714 participants and smoking status recorded at baseline. Fatal and non-fatal MIs and mortality events were regularly recorded. Cox proportional hazard analysis was performed separately for current smokers and non-smokers. We used age as the follow up time, presenting age specific survivals.

Results: During follow up, 248 MIs and 301 and 482 deaths, respectively, due to CHD and CVD occurred. There were no significant differences between the genotypes as regards MI incidence. Among smokers, there was an increased risk of CHD and CVD mortality in carriers of the DD genotype compared to the II genotype, which diminished at later ages (p<0.01 for gene-age interaction). Subgroup analysis in a younger and older group (based on the median age of 68.2 years) showed a significantly increased risk of CVD mortality in the younger group (hazard ratio = 5.19; 95% confidence interval: 1.15 to 23.42).

Conclusions: This study showed that the ACE I/D polymorphism is not a strong risk factor for MI but its interaction with smoking might play a role in cardiovascular mortality especially at younger ages.

     

Cardiovascular risk factors in people with different genotypes in the insertion/deletion (I/D) polymorphism at the locus for angiotensin I-converting enzyme (ACE)

The deletion (D) allele of an insertion/deletion (I/D) polymorphism at the locus for angiotensin I-converting enzyme (ACE) has been reported to be an independent risk factor for myocardial infarction (MI), particularly in people lacking traditional risk factors. Furthermore, a borderline association between Lp(a) lipoprotein level and the I/D polymorphism at the ACE locus was reported in one study. We have searched for possible "level gene" or "variability gene" effects of ACE genes on Lp(a) lipoprotein, total cholesterol (TC), high density lipoprotein (HDL) cholesterol (HDLC), low density lipoprotein (LDL) cholesterol (LDLC), triglycerides (TG), apolipoprotein B (apoB), apolipoprotein A-I (apoA-I), and body mass index (BMI). None of these variables differed significantly between genotypes in the I/D polymorphism in any of three population samples. A single population sample created by combining the three series, exhibited an insignificant trend towards individuals carrying the D-allele having a higher level of Lp(a) lipoprotein than those lacking it, and DD homozygotes had a significantly higher Lp(a) lipoprotein level than the combined group of ID/II individuals (p = 0.03). These results may indicate that the D-allele of the I/D polymorphism at the ACE locus could influence the level of Lp(a) lipoprotein.     

Lack of association of angiotensin-converting enzyme (ACE). Gene insertion/deletion polymorphism with CAD in two Asian populations

Association of the insertion/deletion polymorphism of the angiotensin-converting enzyme ( ACE ) gene with coronary artery disease with or without myocardial infarction (MI) was examined in a group of Chinese and Indian men in Singapore. The sample comprised an angiographically confirmed patient group of 276 Chinese and 102 Indians, of which 155 Chinese and 72 Indians had MI, and a matched healthy control group (147 Chinese and 166 Indians). The frequency of the D allele in the Chinese was 0.39 in those with CAD with MI, 0.43 in those with CAD but without MI, and 0.41 in the control group. The frequency of the D allele in Indians was 0.44 in CAD with or without MI, and 0.45 in the control group. There was no significant association of the ACE gene with CAD or MI in the Chinese or Indians, either in the entire sample or in different risk groups. The frequency of the D allele was significantly lower in the healthy Chinese and Indians than that reported in Caucasians. The association of the ACE gene with MI or CAD observed in other studies could not be confirmed in the present series of Chinese and Indians in Singapore.     

The angiotensin-converting enzyme (ACE) genetic polymorphism: its relationship with plasma ACE level and myocardial infarction

The angiotensin-converting enzyme (ACE) is a key factor in the production of angiotensin II and in the degradation of bradykinin, two important peptides involved in vascular physiology. Plasma and cellular ACE levels in humans are influenced by an insertion (I)/deletion (D) polymorphism of the ACE gene, the ACE I/D polymorphism. The D allele has a frequency of approximately 0.53 in Caucasian populations and is codominantly associated with higher levels of ACE. We have studied this polymorphism in a large multicenter case-control study (the ECTIM study) and found that the D allele was associated with a parental history of fatal myocardial infarction (MI) in the controls and was more frequent in male patients with MI than in controls. This case-control difference was compatible with a codominant effect of allele D on the risk of MI with relative risks of 1.57 for DD vs II and 1.26 for ID vs II (test for trend p < 0.003). In subjects at low risk of MI (plasma ApoB < 1.25 g/1 and body mass index < 26 kg/m²), the relative risk of DD vs ID + II was 2.7 (p < 0.0005). The results were very homogeneous in the four populations included in the study. In a family study, using linkage-segregation analysis, we have shown that the ACE I/D polymorphism is a marker for an unknown functional polymorphism (ACE S/s) which appears to be a new independent risk factor for MI.     

血管紧张素I转换酶基因插入/缺失多态性与人体速度耐力的关联研究

探讨人体血管紧张素I转换酶基因插入/缺失多态性与速度耐力之间的关联性。聚合酶链反应扩增技术检测受试者基因型;测定受试者800 m跑成绩和血乳酸浓度,并对成绩进行逐步聚类分析,将受试者分为高速度耐力组和低速度耐力组。结果发现:高速度耐力组和低速度耐力组组间血管紧张素I转换酶基因型分布及等位基因分布皆无显著性差异(P>0.05);血乳酸浓度无论是安静状态、800 m跑后,还是800 m跑后与安静状态的差值,各基因型组间皆无显著性差异(P>0.05)。人体血管紧张素I转换酶基因插入/缺失多态性与速度耐力无关。     

Association between the ACE I/D gene polymorphism and physical performance in a homogeneous non-elite cohort.

BACKGROUND: I/D polymorphism of the ACE gene may be associated with better endurance performance and a stronger response to exercise training. The aim of this study was to investigate the association between ACE gene polymorphism and athletic performance in a homogeneous cohort. METHODS: Eighty-eight male non-elite Caucasian Turkish athletes with similar training backgrounds for at least for 6 months were studied for ACE gene polymorphisms by PCR analysis. Performance on the 60-meter sprint and middle-distance running tests were evaluated. RESULTS: The distributions of the ACE I/D genotypes were 20.5%, 40.9%, and 38.6% for II, ID, and DD polymorphisms in the whole group (N = 88), respectively. The ACE DD genotype frequency was significantly higher in the superior group (56.7%) than in the poor (37.9%) and mediocre (20.7%) group in middle-distance running performance (chi2 = 11.778; p = 0.019). CONCLUSION: The ACE DD genotype may be related to better short-duration aerobic endurance performance. Larger homogeneous cohorts may help clarify the association between ACE I/D polymorphism and physical performance.     

Association between polymorphism of the angiotensin I converting enzyme gene and hypertension in Turkish type II diabetic patients

It has been suggested that an insertion/deletion (I/D) polymorphism in intron 16 of the angiotensin converting enzyme (ACE) gene may be associated with essential hypertension. The aim of this study was to examine the association between ACE I/D polymorphism with blood pressure level and hypertension status in Turkish type 2' diabetic subjects. Hundred and seven hypertensive (78 female, 29 male) and 132 normotensive type 2 diabetic subjects (73 female, 59 male) and 138 sex and age matched control subjects (87 female, 51 male) without diabetes and hypertension were included into the study. The I/D polymorphism was determined by polymerase chain reaction (PCR). There were no statistically difference in genotypic and allelic frequencies of the ACE I/D polymorphism between the hypertensive and normotensive diabetic patients and control subjects. Also no significant differences was detected in systolic and diastolic blood pressure among three different genotypes. ACE I/D polymorphism does not seem to play an important role in the development of hypertension in Turkish type 2 diabetic subjects, but prospective studies may show an association between ACE gene polymorphism and the development of hypertension in diabetic subjects.     

ACE、AGT基因联合多态性与高血压合并脑梗塞相关

目的探讨北京地区汉族人群血管紧张素转化酶(ACE)基因插入/缺失(I/D)多态性与血管紧张素原(AGT)基因CD235Met-Thr变异(M235T)与高血压合并脑梗塞发生的关系。方法分别用PCR法、突变基因分离聚合酶链反应(MS-PCR)法检测664例高血压合并脑梗塞患者(CI),678例单纯高血压患者(EH)和716例对照者(C)的ACE基因I/D多态性及AGT基因M235T多态性,分析两个基因多态性分布与高血压合并脑梗塞发病的相关性。结果 CI组ACE-DD和AGT-TT基因型频率(分别为0.309和0.643)均显著高于C组(分别为0.203和0.543,P<0.001)和EH组(分别为0.217和0.569,P<0.01)。CI组与C组比较,ACE-DD、AGT-TT联合基因型OR值(2.547,95%CI:1.919～3.382)明显高于ACE-DD单基因型(1.759,95%CI:1.376～2.248)和AGT-TT单基因型(1.515,95%CI:1.220～1.880)。结论 ACE-DD和AGT-TT基因型与北京地区汉族人群单纯高血压发病无相关性,但与高血压合并脑梗塞发病显著相关,并且A...     

心肌梗死患者血管紧张素转换酶基因多态性与ACE、PAI-1活性的相关性

目的:研究心肌梗死(MI)患者血管紧张素转换酶(ACE)基因插入/缺失(I/D)多态性与ACE、PAI-1活性的关系。 方法: 应用PCR方法扩增93例MI患者及87例健康体检者ACE基因特异性片段，同时应用比色法测定血清ACE活性，发色底物法测定PAI-1活性，并对结果进行相关性分析。 结果:①MI组ACE DD基因型频率(32.3%)和D等位基因频率(54.3%)显著高于对照组(12.6%和37.4%)(均P<0.01)。②MI组血清ACE(216.00±58.26)U/L及血浆PAI-1活性(0.85±0.19)AU/mL均显著高于对照组(170.19±48.99)U/L, (0.66±0.20)AU/mL(均P<0.01)；MI组与对照组ACE与PAI-1活性均呈显著正相关(r分别为0.7108，0.7829,均P<0.01)；③MI组DD基因型血清ACE(251.64±57.76)U/L、血浆PAI-1活性(0.96±0.16)AU/mL显著高于ID基因型(211.47±51.87)U/L，(0.82±0.18)AU/mL及Ⅱ基因型(179.84±52.65)U/L，(0.71±0.17)AU/mL(均P<0.01)；ID基因型血清ACE、血浆PAI-1活性亦显著高于Ⅱ型(P<0.05)。对照组DD基因型血清ACE(195.53±54.76)U/L、血浆PAI-1活性(0.78±0.20)AU/mL，显著高于II基因型(154.98±52.74)U/L，(0.59±0.17)AU/mL(均P<0.05)。 结论:由ACE基因所决定的ACE活性，可能参与血浆PAI-1水平的调节；ACE基因I/D多态性与ACE、PAI-1水平相关，ACE基因种类影响纤溶平衡，这可能是其促使MI发病的重要机制之一。     

Association between angiotensin I-converting enzyme gene polymorphism and susceptibility to cancer: a meta analysis

Background: Angiotensin I-converting enzyme (ACE) gene plays an important role in the pathogenesis of cancers. The association between ACE insertion/deletion (I/D) polymorphism and the risk of various cancers has been studied. However, the results of these studies remain conflicting. Therefore, we performed a meta-analysis to evaluate the association between ACE I/D polymorphism and the risk of cancers. Methods: PubMed, Embase, ScienceDirect, Springer, CNKI, Wanfang, Weipu, CBM databases and Google Scholar were searched for case-control studies on ACE I/D polymorphism and the risk of cancers, published up to Dec 31, 2013. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association between ACE I/D polymorphism and cancer risk. Results: Thirty-five published studies with 5007 cases and 8173 controls were included. Overall, there were no significant association between ACE I/D polymorphism and the risk of cancers (II vs. ID+DD OR = 1.05, 95% CI = 0.89-1.23, I vs. D OR = 1.00, 95% CI = 0.89-1.13). However, when stratified by ethnicity, we found a significant association between this polymorphism and cancer risk in Caucasians (II vs. ID+DD: OR = 1.43, 95% CI = 1.02-2.00, I vs. D: OR = 1.23, 95% CI 1.01-1.49). Conclusion: ACE I/D polymorphism is associated with the cancer risk in Caucasians.     

Genetic variation of the angiotensin-converting enzyme gene: increased frequency of the insertion allele in Koreans

In view of the clinical importance of angiotensin-converting enzyme (ACE) as a major marker for cardiovascular diseases, we investigated insertion/deletion ( I/D ) polymorphism of the ACE gene in Koreans. Genotype frequencies were examined by polymerase chain reaction in 171 patients with coronary artery disease (CAD) and 120 healthy subjects. Allele frequencies of ACE polymorphism in Koreans were not significantly different between patient and control groups. In addition, association between ACE genotypes and the number of stenosed coronary arteries was not detected. ACE genotypes in the CAD group were not associated with body mass index and plasma lipid levels. Thus, our results suggest that, at least in Koreans, I/D polymorphism of the gene is unlikely to be a useful marker for CAD subjects. However, the I allele frequency of Koreans (0.58) was higher than that of Caucasian populations (0.47) but lower than that of Samoan (0.91) and Yanomami (0.85) populations. Here, we discuss the clinical and ethnic importance of ACE polymorphism.     

冠心病、原发性高血压人群ACE基因多态性分布及序列测定

目的研究血管紧张素转换酶（ＡＣＥ）基因插入／缺失（Ｉ／Ｄ）多态性在冠心病（ＣＡＤ）、原发性高血压（ＥＨ）和健康人群中的分布,并进行序列分析。方法以多聚酶链反应（ＰＣＲ）方法检测了１３７例ＣＡＤ患者、４２例ＥＨ患者和６３例健康人群的ＡＣＥ基因型,以荧光标记自动测序法测定Ｄ和Ｉ等位基因序列。结果ＣＡＤ组ＤＤ型ＡＣＥ基因出现频率显著高于对照组（０．４５对０．２１,Ｐ＜０．０１）,而ＥＨ组与对照组比较无显著差异。Ｄ等位基因长１９１ｂｐ,Ｉ等位基因长４７９ｂｐ,其核苷酸序列与国外文献报道略有不同。结论ＡＣＥ基因Ｉ／Ｄ多态性是ＣＡＤ发病的独立危险因素,与ＥＨ无相关,ＡＣＥ基因１６内含子中一段２８８ｂｐ的插入片段造成Ｉ／Ｄ多态性。     

The angiotensin-I converting enzyme (ACE) gene I/D polymorphism and ACE levels in Pima Indians.

An insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene is associated with plasma ACE levels in white populations. The occurrence of the I/D polymorphism and relationship to ACE levels was examined in a Pima Indian group (n = 305). The frequency of the D allele was lower in Pimas than whites (0.29 v 0.52 respectively). ACE levels were significantly associated with genotype in both groups (p = 0.0001), which accounted for 6.5% of the variation in ACE levels in Pimas and 18% in whites. The association of the I/D polymorphism with ACE levels confirms the relationship across ethnic groups. The low frequency of the D allele in Pima Indians shows that ethnic differences should be accounted for when studying the ACE gene.     

Association between insertion/deletion polymorphism in angiotensin-converting enzyme gene and acute lung injury/acute respiratory distress syndrome: a meta-analysis

ABSTRACT: BACKGROUND: A previous meta-analysis reported a positive association between an insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene (ACE) and the risk of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Here, we updated this meta-analysis and additionally assessed the association of this polymorphism with ALI/ARDS mortality. METHODS: We searched electronic databases through October 2011 for the terms "angiotensin-converting enzyme gene", "acute lung injury", and "acute respiratory distress syndrome," and reviewed all studies that reported the relationship of the I/D polymorphism in ACE with ALI/ARDS in humans. Seven studies met the inclusion criteria, comprising 532 ALI/ARDS patients, 3032 healthy controls, and 1432 patients without ALI/ARDS. We used three genetic models: the allele, dominant, and recessive models. RESULTS: The ACE I/D polymorphism was not associated with susceptibility to ALI/ARDS for any genetic model. However, the ACE I/D polymorphism was associated with the mortality risk of ALI/ARDS in Asian subjects (Pallele < 0.0001, Pdominant = 0.001, P recessive = 0.002). This finding remained significant after correction for multiple comparisons. CONCLUSIONS: There is a possible association between the ACE I/D polymorphism genotype and the mortality risk of ALI/ARDS in Asians. Akihisa Matsuda and Taro Kishi These authors participated equally in this work.     

The Impact of ACE Genotype on Serum ACE Activity in a Black South African Male Population

The strong association between the angiotensin I-converting enzyme (ACE) gene I/D polymorphism with serum ACE activity appears lacking in Nigerians and Kenyans, but has not previously been well assessed in others of African origin. This study addressed this issue in an ethnically well defined black South African population. A putative association for the A22982G ACE gene variant, a QTL likely to impact on serum ACE activity, was also sought.
Subjects were 200 healthy male black South African volunteers from the Xhosa ethnic group. Venous blood was obtained from all subjects for DNA extraction. ACE I/D and A22982G genotypes were determined and serum ACE activity measured. Age and blood pressure were recorded. For the group as a whole (mean ± SD age 38.5 ± 9.8 years, SBP 119.6 ± 14.1 mmHg, DBP 78.2 ± 10.1 mmHg) serum ACE activity was 38.2 ± 11.2 nmol ml⁻¹min⁻¹. ACE I/D genotype was not significantly associated with serum ACE activity. In contrast, the A22982G variant was significantly associated with serum ACE activity, being 35.9 ± 9.6, 38.1 ± 10.6 and 42.4 ± 15.3 nmol ml⁻¹min⁻¹ for AA, AG and GG genotypes respectively; p = 0.03 by ANOVA and p = 0.01 by linear trend.
In keeping with the findings in some other African populations, the ACE I/D polymorphism is not strongly associated with serum ACE activity in Xhosa South Africans. As such, it cannot be used as a marker of ACE activity in these subjects. In this regard the use of the A22982G gene variant may be more appropriate.     

The angiotensin converting enzyme genetic polymorphism in acute coronary syndrome--ACE polymorphism as a risk factor of acute coronary syndrome.

The deletion polymorphism of angiotensin converting enzyme (ACE) genotype has been reported as an independent risk factor for the development of myocardial infarction (MI). However there are conflicting data showing no relationship between the ACE genotype and coronary artery disease. The present study was performed to investigate the correlation between ACE genetic polymorphism and acute coronary syndrome by comparing the distribution of ACE genotypes and ACE activities in patients with acute MI and unstable angina with those in control group. The frequency of genotype DD was significantly higher in patients with acute coronary syndrome than in controls. Logistic regression analysis showed that ACE polymorphism affected the development of acute coronary syndrome in recessive pattern of D allele. When we divided the patients into MI and unstable angina groups, the frequencies of genotype DD and D allele were significantly higher in unstable angina group than in MI or control groups. In the patients with MI, the frequency of D allele was significantly higher in patients without previous angina than in those with previous angina. There was no significant difference in ACE genotype or allelic frequency according to the severity of coronary lesions. The ACE genotype was associated with marked differences of ACE activity, but there was no difference between the patient and control groups for each genotype. In conclusion, the genotype DD of ACE gene associated with acute coronary syndrome, but not with the severity of coronary artery lesion. These results showed that the genotype DD of ACE gene might be associated with acute coronary syndrome by another mechanism rather than the coronary atherosclerosis.     

Association of the ACE gene polymorphism with the progression of autosomal dominant polycystic kidney disease

Renin-angiotensin system is considered important in the genesis of hypertension and development of end-stage renal disease (ESRD) in autosomal dominant polycystic kidney disease (ADPKD). The angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism has been associated with susceptibility to the development of some renal diseases. We investigated the association of ACE gene polymorphism with the progression to hypertension and ESRD in 108 patients with ADPKD. The ACE I/D polymorphism was amplified with the flanking primers by polymerase chain reaction. In patients genotyped for ACE gene polymorphism, the frequencies of DD (15%), ID (51%) and II (34%) genotypes were similar to those of the general population. Of the 108 patients, 64 (59%) developed hypertension and 24 (22%) reached ESRD at the time of study. The prevalence of hypertension was not significantly different among the three genotypes. The mean renal survival time was 53-6 yr in II genotype, 55+/-10 yr in ID genotype and 52+/-9 yr in DD genotype which was not significantly different among them. Cumulative renal survival was not significantly different either. There was no association of ACE gene polymorphism with the prevalence of hypertension and renal survival in ADPKD. We suggest that ACE I/D polymorphism is not an important modifying gene in the progression of ADPKD.