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β 2 ‐Adrenergic receptor polymorphisms and treatment‐induced regression of left ventricular hypertrophy in hypertension
Author(s) -
Iaccarino Guido,
Izzo Raffaele,
Trimarco Valentina,
Cipolletta Ersilia,
Lanni Francesca,
Sorriento Daniela,
Iovino Gianni Luigi,
Rozza Francesco,
Luca Nicola,
Priante Ornella,
Di Renzo Gianfranco,
Trimarco Bruno
Publication year - 2006
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1016/j.clpt.2006.09.006
Subject(s) - muscle hypertrophy , medicine , left ventricular hypertrophy , blood pressure , atenolol , endocrinology , allele , cardiology , enalapril , population , receptor , genotype , biology , genetics , angiotensin converting enzyme , environmental health , gene
Objectives Although blood pressure is considered the major determinant of left ventricular hypertrophy in hypertension, genetic variability is increasingly being considered among the factors influencing this complication. β 2 ‐Adrenergic receptors (β 2 ARs) are up‐regulated in hypertension and largely polymorphic within the human population. Recently, we have shown that the Glu27 β 2 AR variant is strongly associated with cardiac hypertrophy in hypertension. The objective of this study is to verify whether this polymorphism also affects hypertrophy regression in response to antihypertensive therapy. Methods In a prospective follow‐up study we screened 970 hypertensive patients of Caucasian descent for the Gly16Arg, Gln27Glu, and Thr164Ile β 2 AR polymorphisms and left ventricular echocardiographic hypertrophy and assigned selected patients to enalapril or atenolol to assess left ventricular hypertrophy regression after 2‐year follow‐up. Results were stratified according to treatment and the Glu27Gln polymorphism of the β 2 AR. In cells with stable overexpression of the Glu27 or Gln27 variant of β 2 AR, we also explored the implications of this polymorphism on hypertrophy‐related intracellular signal transduction. Results Among hypertensive patients, the Gly16 allele was found in 63% of patients and the Glu27 allele was found in 40.6%. Both polymorphisms were in linkage disequilibrium, as expected. Four hundred forty‐one hypertrophic hypertensive patients completed the 2‐year follow‐up. At baseline, patients carrying at least 1 allele of the Glu27 variant presented with a larger cardiac size despite similar blood pressure levels (142.9 ± 22.5 g/m 2 in Glu27 carriers versus 138.2 ± 18.4 g/m 2 in Gln27 carriers, P < .02). Blood pressure normalization was achieved by both drugs. At follow‐up, compared with the Gln27 patients, the Glu27 patients showed a larger reduction in hypertrophy when treated with enalapril (percent change in left ventricular mass, −6.3% ± 7.7% in Glu27 carriers versus −2.18% ± 7.9% in Gln27 carriers; P < .05) but not with atenolol therapy (−2.8% ± 8.9% in Glu27 carriers versus −2.4% ± 8.8% in Gln27 carriers, P = not significant). In in vitro studies the activation of p38 and extracellular signal‐regulated kinase (ERK‐) 1/2 (data not shown) and the activity of the atrial natriuretic factor (ANF) promoter after isoproterenol (INN, isoprenaline) stimulation were larger in Glu27 β 2 AR overexpressing cells than in Gln27 β 2 AR overexpressing cells (fold difference compared with unstimulated cells, 9.7 ± 2.9 for Glu27 β 2 AR versus 4.2 ± 0.3 for Gln27 β 2 AR; P < .05). Conclusions The Glu27 variant of β 2 AR enhances hypertension‐induced left ventricular hypertrophy. In these patients angiotensin‐converting enzyme inhibitors are more efficient than β‐blockers in reducing cardiac size. Clinical Pharmacology & Therapeutics (2006) 80 , 633–645; doi: 10.1016/j.clpt.2006.09.006