Conclusion

Several questions regarding the clinical utility of ACE genotyping remain unresolved. The clinical trials studying the correlation of ACE genotype and response to treatment with ACE inhibitors in patients with essential hypertension or kidney disease do not give a clear answer (Tables 1 and 2). Some of the studies have to be dealt with great caution because of small patient numbers and heterogeneous baseline characteristics. Even the choice of ACE inhibitor might have influenced the results of these clinical trials because it has been shown that ACE inhibitors differ in their affinity to ACE.[34] Finally, one has to consider if the ACE I/D polymorphism is the best of the hitherto described genetic markers for pharmacogenomic studies, as its clinical significance and its linkage to pathologies is still controversial.[35] Direct measurement of enzyme activity may not only allow a better estimation of individual risk but provide a basis for more effective treatment with ACE inhibitors as well.

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