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R S Cooper

Publications and source records attributed to R S Cooper.

At least 37 records · Page 2Linked to original sources
PubMed2001

Testing quantitative traits for association and linkage in the presence or absence of parental data.

Zhu and Elston developed a transmission disequilibrium test for quantitative traits by defining a linear transformation to condition out founder information. The method tests the null hypothesis of no linkage or association and can be applied to general pedigree structures. However, this method requires both genotype and phenotype parental information, which may be difficult to obtain. In this paper, we describe parametric and non-parametric methods to relax this requirement when only nuclear families are sampled. We show that neither method is affected by population stratification in the absence of linkage. The statistical power and validity of the tests are investigated by simulation. A simple simulation method to calculate the power of the nonparametric method is also discussed. In practice, the data may have some families with parental phenotype and genotype information available and some without. We briefly discuss how all the data may be analyzed jointly.

Computer Simulation↗
PubMed2001

Coronary angiographic findings in African-American and white patients from a single institution.

No data exist comparing clinical and angiographic findings in large numbers of contemporary African-American and white patients from the same hospital. Limited angiographic data on African Americans were obtained from hospitals serving predominantly minority patients, making the valid African-American:white comparisons difficult. The study included 2,624 consecutive white and 1,793 African-American patients who had angiography for diagnostic evaluation of presumed coronary artery disease at the Louisiana State University Medical Center in Shreveport between 1990 and 1997. Compared to whites of the same sex, a greater proportion of African-American patients had a history of hypertension, stroke, and heart failure. African Americans also had significantly higher systemic and left ventricular pressure, lower ejection fraction, greater echocardiographic left ventricular mass index, and more concentric hypertrophy. The overall proportion of patients with normal or minimal stenosis of coronary artery (<50% narrowing in the luminal diameter) was greater in African Americans than in whites for both men and women. This difference was predominately found in men aged > or = 55 years or older. Except among older men, African-American patients with coronary heart disease had a similar distribution of 1-, 2-, 3-vessel disease and mean stenosis score compared to whites. In conclusion, a higher frequency of normal coronaries and less frequent coronary stenosis were found in older African-American men. The African-American:white differences in angiographic findings were minimal in younger men and in women. However, African Americans had worse clinical profiles than whites.

Adult↗
PubMed2000

A first high-density map of 981 biallelic markers on human chromosome 14.

As the largest set of sequence variants, single-nucleotide polymorphisms (SNPs) constitute powerful assets for mapping genes and mutations related to common diseases and for pharmacogenetic studies. A major goal in human genetics is to establish a high-density map of the genome containing several hundred thousand SNPs. Here we assayed 3.7 Mb (154,397 bp in 24 alleles) of chromosome 14 expressed sequence tags (ESTs) and sequence-tagged sites, for sequence variation in DNA samples from 12 African individuals. We identified and mapped 480 biallelic markers (459 SNPs and 21 small insertions and deletions), equally distributed between EST and non-EST classes. Extensive research in public databases also yielded 604 chromosome 14 SNPs (dbSNPs), 520 of which could be mapped and 19 of which are common between CNG (i.e., identified at the Centre National de Génotypage) and dbSNP polymorphisms. We present a dense map of SNP variation of human chromosome 14 based on 981 nonredundant biallelic markers present among 1345 radiation hybrid mapped sequence objects. Next, bioinformatic tools allowed 945 significant sequence alignments to chromosome 14 contigs, giving the precise chromosome sequence position for 70% of the mapped sequences and SNPs. In addition, these tools also permitted the identification and mapping of 273 SNPs in 159 known genes. The availability of this SNP map will permit a wide range of genetic studies on a complete chromosome. The recognition of 45 genes with multiple SNPs, by allowing the construction of haplotypes, should facilitate pharmacogenetic studies in the corresponding regions.

Alleles↗
PubMed2000

Localization of a small genomic region associated with elevated ACE.

Defining the relationship between multiple polymorphisms in a small genomic region and an underlying quantitative trait locus (QTL) represents a major challenge in human genetics. Pedigree analyses have shown that angiotensin I-converting enzyme (ACE) levels are influenced by a QTL located within or close to the ACE gene and most likely resides in the 3' region of this locus. We genotyped seven polymorphisms spanning 13 kb in the 3' end of ACE in 159 Afro-Caribbean subjects to evaluate the linkage disequilibrium between these sites and to narrow the genomic region associated with an elevated ACE level using a cladistic analysis. The linkage disequilibrium measurement D' and a haplotype tree revealed three distinct haplotype segments, presumably because of recombination. The value of the linkage disequilibrium parameter p(excess) was highest for site 22982, which is located in the middle segment. A series of nested, cladistic analyses confirmed that the other two regions are unlikely to be the ACE-linked QTL and that the variant resides in the middle region. Analyses of the same polymorphisms in 98 unrelated Europeans in the Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) study resulted in fewer haplotypes than were observed among the Afro-Caribbean subjects, suggesting that populations with greater genetic diversity may be especially informative for fine-scale mapping.

Black People↗
PubMed2000

Alcohol intake and mortality: findings from the National Health Interview Surveys (1988 and 1990).

The authors used prospective data from two supplemental studies of the National Health Interview Survey, the 1988 Alcohol Supplement and the 1990 Health Promotion and Disease Prevention Supplement, to examine the relation between alcohol intake and mortality. Their study included 17,821 men and 25,874 women aged 40 years or older at baseline; during an average of 6 years of follow-up, 5,540 deaths occurred. The alcohol-mortality relation was U-shaped for men and J-shaped for women. On the basis of categorical analyses adjusted for age, race, smoking, and baseline diseases, men who drank 2 drinks per day had a significantly lower risk of death compared with abstainers (relative risk = 0.60, 95% confidence interval (CI): 0.45, 0.82). The relative risk was 0.75 (95% CI: 0.55, 1.03) after further adjustment for marital status, education, and self-perceived health status. For women, the corresponding relative risks were 0.69 (95% CI: 0.61, 0.78) and 0.79 (95% CI: 0.70, 0.90) for those who drank less than 1 drink per day. When drinking category was considered as an ordinal variable and fitted with a quadratic function in the Cox model, the estimated optimal alcohol intake was approximately less than 1 to 1 drink per day for men and lifetime infrequent to less than 1 drink per day for women. Data from these representative US cohorts demonstrated that less than 2 drinks per day for men and less than 1 drink per day for women are associated with the lowest all-cause mortality.

Alcohol Drinking↗
PubMed2000

Quality of the last year of life of older adults: 1986 vs 1993.

CONTEXT: The population is aging and life expectancy is increasing, but whether morbidity and disability late in life also increase is unknown. OBJECTIVE: To examine whether the use of health care services, disability and cognitive function, and overall quality of life in the year before death among older adults has changed over time. DESIGN AND SETTING: The 1986 and 1993 National Mortality Followback Surveys, which were probability samples of all deaths in the United States with response rates of next of kin of 90% and 88% for those aged 65 years and older. PARTICIPANTS: Next of kin were asked to report the health status of a total of 9179 decedents who were 65 years and older in 1986 and 6735 in 1993, representing 1.5 and 1.6 million decedents aged 65 years and older. MAIN OUTCOME MEASURES: Days of hospital or nursing home stays, number and length of disability in 5 activities of daily living, duration of impairment in 3 measures of cognitive function, and an overall sickness score among individuals aged 65 through 84 years and those aged 85 years and older. RESULTS: Women used significantly fewer hospital and nursing home services in the last year of life in 1993 vs 1986 (mean reduction, 3.3 nights for both age groups for hospital services; mean reduction 18.4 nights for nursing home for women aged 65-84 years and 42.3 nights for women > or =85 years). Men had no changes except those aged 85 years and older had a decline in nursing home nights of 32.6. The proportion of women aged 85 years and older with restriction of at least 2 activities of daily living decreased from 62.5% in 1986 to 52.1% in 1993 (P<.01), and those with normal cognitive function increased from 50.3% to 56.2% (P<.05). Their mean overall sickness score decreased and quality-of-life improved. Among women aged 65 through 84 years, the number with normal cognitive function increased and the mean sickness score decreased, but those with at least 2 activities of daily living impairments increased and the overall quality of life declined. A similar pattern of change was found in the oldest-old men except that cognitive function worsened. Most parameters for men aged 65 through 84 years did not change significantly. CONCLUSIONS: Men and women at least 85 years old in the US experienced a better overall quality of life in the last year of life in 1993 than those in 1986. Most measures for men and women aged 65 through 84 years improved or did not change.

Activities of Daily Living↗
PubMed2000

Predictive values of waist circumference for dyslipidemia, type 2 diabetes and hypertension in overweight White, Black, and Hispanic American adults.

Waist circumferences (WC) >/=102 cm for men and >/=88 cm for women have been proposed by an expert panel as cut-points for identifying increased risk for the development of obesity comorbidities for most adults. The aim of this investigation was to examine the predictive values of these WC cut-points for hypercholesterolemia, low concentration of high (HDL-C), and high concentration of low (LDL-C) density lipoprotein cholesterol, hypertriglyceridemia, type 2 diabetes, and hypertension in overweight American adults. Data from NHANES III were utilized for the analysis. Predictive abilities were determined by calculating sensitivity, specificity, positive (PV+) and negative (PV-) predictive values in overweight subjects with BMI 25-29.9 kg/m(2). Sensitivity of WC cut-point was stronger for high LDL-C compared to other risk factors with the highest values recorded in the 40-59 and 60-69 year age groups in men and women, respectively. PV+ of WC cut-points for dyslipidemia, type 2 diabetes, and hypertension were low in men compared to women. PV+ tended to increase with age, from 19-39, 40-59 to 60-90 year age groups in Whites, Blacks, and Hispanic men. In men, the highest PV+ were recorded for hypertriglyceridemia in the 60-90 years old groups, with values of 71.6%, 52.5%, and 43.3% in Whites, Blacks, and Hispanics, respectively. The CVD risk factor associated with the highest PV+ in women was diabetes with values of 97.2% in Whites and 88.9% in Blacks, and hypertriglyceridemia with a value of 93.8% in the 17-39 year age group in Hispanics. Among Black men 40-59 years of age, only 32% of a population of overweight hypertensives were detected by the WC cut-points, and among Black women, 40-59 years of age, only 54% were detected. Given the low sensitivity of these cut-points for detecting hypertension, one of the major co-morbidities of obesity, these cut-points failed to provide adequate evidence for the use of WC in determining or evaluating patients as to co-morbid states. We recommend further studies to determine a set of specific cut-points associated with increased risk of CVD in different population groups.

Adolescent↗
PubMed2000

Lack of association between a biallelic polymorphism in the adducin gene and blood pressure in whites and African Americans.

Population-based candidate gene association analyses are becoming increasingly popular as a result of a greater number of genes and gene polymorphisms having been identified for which some functional information is available. Because many biochemical and physiologic systems impact blood pressure regulation and hypertension susceptibility, many of these identified genes and polymorphisms are candidates for population-level association studies involving blood pressure levels or hypertension status. Recent studies have suggested that the alpha-adducin gene may harbor polymorphisms that influence blood pressure level. Therefore, we embarked on a study to test one such polymorphism in two large US samples: one from an urban African American population (Maywood, IL) and another from a rural white population (Tecumseh, MI). We used both family-based association tests and tests that consider the impact of additional measured factors beyond adducin gene variation on blood pressure levels. We found no evidence for a significant effect of the chosen adducin polymorphism on blood pressure variation in either sample. We also found no association between Adducin genotypes and antihypertensive use. These facts, together with similar findings in companion studies, suggest that the alpha-adducin gene polymorphism does not have a pronounced effect on blood pressure variation in the populations studied. This does not suggest, however, that the alpha-adducin gene does not have a role in blood pressure regulation and hypertension susceptibility.

Adult↗
PubMed2000

Abdominal adiposity and clustering of multiple metabolic syndrome in White, Black and Hispanic americans.

PURPOSE: The aim of this study was to evaluate the association of abdominal adiposity assessed by waist circumference (WC) with clustering of multiple metabolic syndromes (MMS) in White, Black and Hispanic Americans. MMS was defined as the occurrence of two or more of either hypertension, type 2 diabetes mellitus, dyslipidemia, hypertriglyceridemia or hyperinsulinemia. METHODS: The number of MMS and fasting insulin (a surrogate measure of MMS) were each used as dependent variables in gender-specific multiple linear regression models, adjusting for age, smoking and alcohol intake. The contribution of WC to interethnic differences in clustering of MMS and fasting insulin concentration was assessed in gender-specific linear regression models. The risk of MMS due to large waist was estimated by comparing odds ratio for men with WC >/= 102 cm with those with WC < 102, and women with WC >/= 88 cm with women with WC < 88 cm in the logistic regression model adjusting for age, smoking and alcohol intake. RESULTS: WC was positively and independently associated with clustering of MMS and increased fasting insulin concentration adjusting for age, smoking and alcohol intake in the three ethnic groups (p < 0.01). Black ethnicity was associated with clustering of MMS and fasting insulin concentration (p < 0.01). Hispanic ethnicity was also associated with clustering of MMS in men and associated with fasting insulin concentration in both men and women (p < 0.01). In both men and women, the risk of MMS clustering was strongly associated with increased WC in all ethnic groups independent of BMI. CONCLUSION: WC appears to be a marker for multiple metabolic syndromes in these ethnic groups. The results of this investigation lend support to the view that waist measurement should be considered as a clinical variable for assessing the risk of cardiovascular diseases.

Abdomen↗
PubMed2000

Comparability of resting energy expenditure in Nigerians and U.S. blacks.

OBJECTIVE: To determine the influence of environmental factors on resting energy expenditure (REE) and its relationship to adiposity in two populations of West African origin, Nigerians and U.S. blacks. RESEARCH METHODS AND PROCEDURES: REE and body composition were measured in a cross-sectional sample of 89 Nigerian adults (39 women and 50 men), and 181 U.S. black adults (117 women and 65 men). Both groups represent randomly selected population samples. REE was measured by indirect calorimetry after an overnight fast in both sites using the same instrument. Body composition was estimated using bioelectrical impedance analysis (BIA) in 72 Nigerians and 156 U.S. participants. Multivariate regression analysis was used to determine the significant predictors of REE. The analyses were repeated in a set of 17 Nigerians and 28 U.S. blacks in whom body composition was measured using deuterium dilution. RESULTS: U.S. black adults were significantly heavier and had both more fat-free mass (FFM) and body fat than Nigerians. FFM was the only significant determinant of REE in both population groups, whether body composition was measured using BIA or deuterium dilution. The relationship between REE and body composition did not differ by site. There was no relationship between REE and adiposity. DISCUSSION: Differences in current environmental settings did not impact REE. The differences observed in mean levels of body fat between Nigerians and U.S. blacks were not the result of differences in REE adjusted for body composition.

Adipose Tissue↗
PubMed2000

Predictive value of abdominal obesity cut-off points for hypertension in blacks from west African and Caribbean island nations.

BACKGROUND: Waist circumferences (WC) >/=94 cm for men and >/=80 cm for women (action level I) and >/=102 cm for men and >/=88 cm for women (action level II) have been suggested as limits for health promotion purposes to alert the general public to the need for weight loss. In this analysis we examined the ability of the above cut-off points to correctly identify subjects with or without hypertension in Nigeria, Cameroon, Jamaica, St Lucia and Barbados. We also determined population- and gender-specific abdominal adiposity cut-off points for epidemiological identification of risk of hypertension. METHODS: Waist measurement was made at the narrowest part of the torso as seen from the front or at midpoint between the bottom of the rib cage and 2 cm above the top of the iliac crest. Sensitivity and specificity of the established WC cut-off points for hypertension were compared across sites. With receiver operating characteristics (ROC), population- and gender-specific cut-off points associated with risk of hypertension were determined over the entire range of WC values. RESULTS: Predictive abilities of the established WC cut-off points for hypertension were poor compared to the specific cut-off points estimated for each population. Different values of WC were associated with increased risk of hypertension in these populations. In men, WC cut-off points of 76, 81, 80, 83 and 87 cm provided the highest sensitivity for identifying hypertensives in Nigeria, Cameroon, Jamaica, St Lucia and Barbados, respectively. The analogous cut-off points in women were 72, 82, 85, 86 and 88 cm. CONCLUSIONS: The waist cut-off points from this study represent values for epidemiological identification of risk of hypertension. For the purpose of health promotion, the decision on what cut-off points to use must be made by considering other additional factors including overall impact on health due to intervention (e.g. weight reduction) and potential burden on health services if a low cut-off point is employed. There is a need to develop abdominal adiposity cut-off points associated with increased risks for cardiovascular diseases in different societies, especially for those populations where the distribution of obesity and associated risk factors tends to be very different from those of the technologically advanced nations. International Journal of Obesity (2000) 24, 180-186

Abdomen↗
PubMed2000

Impact of birth weight on ethnic variations in subcutaneous and central adiposity in American children aged 5-11 years. A study from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To determine the types of subcutaneous adiposity represented by different measurements of skinfold thickness that are associated with birth weight in white (n=759), Black (n=916) and Hispanic (n=813) American children aged 5-11 y. We also determined the contribution of birth weight to ethnic differences in subcutaneous and central adiposity. DESIGN AND METHODS: Data for this analysis were from the Third US National Health and Nutrition Examination Survey. The outcome measures were triceps, subscapular, suprailiac and thigh skinfold thicknesses at 5-11 y of age. Central adiposity was defined as ratios of subscapular to triceps (STR) and central-peripheral (CPR) (subscapular+suprailiac)/(triceps+thigh) skinfolds. Partial correlation analyses were used to determine the association between birth weight and measures of subcutaneous fatness, while multiple linear regression analyses were used to determine the independent contribution of birth weight to ethnicity variations in subcutaneous and central adiposity adjusting for sex, age and BMI. RESULTS: Overall, birth weight was negatively associated with subscapular skinfold and central adiposity in White, Black and Hispanic American children (P < 0.05). Birth weight was also negatively associated with suprailliac skinfold in both Blacks and Hispanics (P < 0.01) and with sum of the four skinfolds in Blacks (P < 0.05). Compared with White, Black ethnicity was negatively associated with triceps, suprailliac thigh and sum of skinfold thicknesses controlling for birth weight, sex, age and BMI (P < 0.01). Compared with White, Hispanic ethnicity was negatively associated with triceps, thigh and sum of skinfold thicknesses (P < 0.01). Both Black and Hispanic ethnicity was positively associated with STR and CPR (P < 0.01). CONCLUSIONS: In this population of American children, the association of birth weights with subcutaneous and central fat accumulation may be due to fetal programming. Since the impact of fetal conditions is likely to be modified by life course, defining the interaction between factors that are present at birth and subsequent exposures is one of the essential challenges for future research.

Adipose Tissue↗
PubMed2000

Hypertension in a black population: prevalence and biosocial determinants of high blood pressure in a group of urban Nigerians.

AIMS: To define the prevalence of hypertension, a major cause of morbidity and mortality in blacks, and related biosocial factors in an urban African population group. METHODS: The setting was that of a civil service population in Ibadan, a major city in Southwestern Nigeria. Nine hundred and ninety-eight civil servants selected by multistage sampling participated in the survey. Biosocial data including smoking history, alcohol use and level of physical activity; anthropometry, blood pressure and plasma glucose measurements were obtained. Diagnosis of hypertension was based on blood pressure of > or =160/95 mm Hg or known hypertensive on treatment. RESULTS: The overall prevalence rate of hypertension was 10.3% (CI, 8.4%, 12.2%), rates of 13.9% and 5.3% were obtained in men and women respectively in spite of a much higher rate of generalised obesity in the latter. Hypertension was associated with higher salary grade level, but there was no relationship found with regular exercise, smoking and alcohol. Obesity (body mass index (BMI) > or =30 kg/m2) was associated with hypertension only in women. A two-sided t-test demonstrated age, waist circumference, waist to hip ratio (WHR) and plasma glucose level as significant variables. In multivariate ANOVA models of systolic blood pressures, age, male sex and BMI were highly significant factors (P < 0.0001) and plasma glucose was also significant (P < 0.016); the same variables (except plasma glucose) were associated with diastolic blood pressures. In logistic regression models the variables which predicted hypertension were WHR, plasma glucose, age, sex and family history of diabetes. CONCLUSIONS: Prevalence of hypertension in the study was comparable to recently reported rates in urban Nigeria and similar populations in Africa. The biosocial determinants of hypertension in the urban black population were age, male gender, higher socio-economic status, BMI, plasma glucose, generalised and central adiposity. Regional fat distribution was a stronger predictor of hypertension than generalised obesity in the population.

Adult↗
PubMed2000

Ethnic differences in the rates of low birth weight attributable to differences in early motherhood: a study from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To estimate the impact of early motherhood (being a mother at < 20 years of age) on ethnic differences in the risk of low birth weight (LBW) in a representative sample (n = 9141) of American infants and children. METHODS: Risks for LBW and the population-attributable fraction due to early motherhood were estimated adjusting for maternal smoking and education in logistic regression models. The contribution of early motherhood to ethnic differences in the risks of LBW was determined using a relative attributable risk estimate that compared Hispanics and Blacks with Whites. RESULTS: Early motherhood was independently associated with increased risk of LBW in each of the three ethnic groups, adjusting for maternal smoking during pregnancy and education. Hispanic and Black ethnicity were each associated with 15% and 123% increased risk of LBW relative to Whites. The population-attributable fractions of LBW due to early motherhood were 6.2%, 7.4%, and 2.3%, for Whites, Hispanics, and Blacks, respectively. The responses of early motherhood for LBW were different among the three ethnic groups (p < 0.05). Adjusting for maternal smoking and education, 4.8% and 7.4% of the differences in the risk of LBW between Whites and Hispanics and between Whites and Blacks, respectively, were due to differences in early motherhood. CONCLUSION: The result of this study underscores the risk of LBW due to early motherhood. Because early motherhood is preventable and avoidable, appropriate public health strategies to educate young women on the need to delay childbearing in these ethnic groups, particularly among Hispanics and Blacks, are warranted.

Black or African American↗
PubMed2000

Transvenous pacemaker insertion ipsilateral to chronic subclavian vein obstruction: an operative technique for children and adults.

Subclavian vein occlusion limits insertion of pacing electrodes in children and adults. The concern is greatest in children with a long-term need for pacing systems necessitating use of the contralateral vein and potential bilateral loss of access in the future. We describe an operative technique to provide ipsilateral access in chronic subclavian vein occlusion in five consecutive pediatric (n = 4, mean age 6.5 years) and adult (n = 1, age 70 with bilateral subclavian vein occlusion) patients in whom this condition was noted at the time of pacemaker or ICD implant. Occlusion was documented by venography. Pediatric cardiac diagnoses included complete heart block in all patients, tetralogy of Fallot in three, and L-transposition of the great vessels in one. Percutaneous brachiocephalic (innominate) or deep subclavian venous access was achieved by a supraclavicular approach using an 18-gauge Deseret angiocath, a Terumo Glidewire, and dilation to permit one or two 9-11 Fr sheaths. Electrode(s) were positioned in the heart and tunneled (pre- or retroclavicularly) to a pre- or retropectoral pocket. Pacemaker and ICD implants were successful in all without any complication of pneumothorax, arterial or nerve injury, or need for transfusion. Inadvertent arterial access did not occur as compared with prior infraclavicular attempts. One preclavicularly tunneled electrode dislodged with extreme exertion and was revised. Ipsilateral transvenous access for pacemaker or ICD is possible via a deep supraclavicular percutaneous approach when the subclavian venous obstruction is discovered at the time of implant. In children, it avoids the use of the contralateral vein that may be needed for future pacing systems in adulthood. This venous approach provides access large enough to allow even dual chamber pacing in children and can be accomplished safely.

Aged↗
PubMed2000

Influence of the I/D polymorphism of the angiotensin-converting enzyme gene on the outcome of microalbuminuria in essential hypertension.

The objective of the present study was to analyze the influence of the I/D polymorphism of the ACE gene on the outcome of microalbuminuria in essential hypertensive patients who were receiving antihypertensive treatment. One hundred thirty-six essential hypertensive patients who were <50 years old and had never previously received treatment with antihypertensive drugs were included in the study. During a 3-year period, patients received nonpharmacological treatment consisting of moderate salt restriction and a low-calorie diet they were obese, with or without a regimen of antihypertensive drugs based on beta-blockers or ACE inhibitors. Hydrochlorothiazide was added when necessary to maintain the blood pressure goal of <135/85 mm Hg. At the beginning of the study and at yearly intervals, systolic and diastolic blood pressures (SBP and DBP, respectively), 24-hour urinary albumin excretion (UAE), renal function, and biochemical profile measurements were made. The insertion/deletion (I/D) polymorphism of the ACE gene was determined through the use of polymerase chain reaction. The variables used in the statistical analysis were the measurements at the start of the study and the increase or decrease detected during the follow-up, estimated as individual specific regression line slope values. At baseline, no differences in blood pressure or UAE values were observed among genotypes. Likewise, the genotype or allele frequency was not significantly different between normoalbuminurics and microalbuminurics. After the 3 treatment years, significant reductions in SBP, DBP, and UAE were found (SBP 151.6+/-17.3 reduced to 137.2+/-14.3 mm Hg, P<0.001; DBP 96.6+/-8.9 reduced to 84.5+/-9.8 mm Hg, P<0.001; UAE 36.7+/-71.5 reduced to 28.3+/-78.6 mg/24 h, P<0. 05). The slopes of these parameters over time did not differ significantly among genotypes. The slope of SBP was the main factor related to the slope of logUAE (P<0.003). A significant positive correlation coefficient between the SBP and logUAE slopes was observed for the DD patients (r=0.57, P<0.0001) but was absent in patients carrying the I allele (II r=-0.03, P=NS; I/D r=0.01, P=NS). Follow-up studies should be used to achieve a better understanding of the impact of candidate gene polymorphisms on the development of hypertension-induced organ damage. Assessment of the I/D polymorphism of the ACE gene may identify subjects who require a greatly lowered blood pressure to prevent organ damage and to reduce hypertension-associated complications and death.

Adult↗