Object of the study: essential hypertension. Purpose of the study: to improve the efficacy of the therapy for arterial hypertension (AH) on the basis of the study of the effect produced by I/D polymorphism of the angiotensin-converting enzyme (ACE) gene on the efficacy of ACE inhibitors and sartans. Methods of the investigation: general clinical, laboratory, biochemical (kinetic, polymerase chain reaction followed by electrophoresis in an agarose gel), instrumental and statistical ones. Theoretical and practical results: the detection of ACE gene polymorphism in AH patients makes it possible to isolate in them a high-risk group for carrying out measures of the purposeful prevention of AH complications, as well as to increase the efficacy of treating AH patients by a differential approach to the administration of the antihypertensive therapy, giving preference to ACE inhibitors (ACEi) in type II and sartans in D allele carriers. Novelty: the influence of I/D polymorphism of ACE gene on the clinical course of AH was revealed. The most significant changes were found out in patients with the homozygous type of the inheritance of D and I alleles. If compared with genotype II, DD one is characterized by bad heredity of AH, a more severe course of the disease, chronic heart insufficiency and a more common development of concomitant diseases: diabetes mellitus and coronary disease; whereas genotype II has protective properties, as it is testified by a later age of AH manifestation and a mainly symptomless course of the disease. The presence of D allele was associated with higher values of the systolic and diastolic blood pressure (SBP and DBP) and a larger expressiveness in the development of myocardial hypertrophy in the left ventricle. For the first time, a relationship was revealed between the efficacy of the antihypertensive therapy with of the rennin-angiotensin system blockers (ACEi and sartans) and I/D polymorphism of ACE gene. Thus, the efficacy of ACEi was more expressed in people with the homozygous type of the inheritance of I allele: decreases of SBP by 19 % and DBP by 16.1 %, achievement of the planned blood pressure (BP) with the monotherapy in 89 % of cases, while in DD genotype these indices were 17.8 %, 12.8 % and 50 %, respectively. Sartans were more effective in the carriers of D allele: decreases of SBP by 21.2 % and DBP by 20.4 %, achievement of the planned BP with the monotherapy in 79 % of cases, while in genotype II these indices were, respectively, 18.2 %, 16 % and 64 %. Degree of introduction: results of the conducted study were introduced in the practical work of the Therapeutics Department of the State Institution “Railway Hospital of Kharkiv Station” of the statutory territory-trade association “The Southern Railway”, the Cardiological Department of the Military Medical Clinical Centre of the Northern Region, cardiological ad therapeutics departments of Kharkiv City Hospital No. 8, as well as in the educational process at the Department of Cardiology and Functional Diagnosis of Kharkiv Medical Academy of Postgraduate Education. Sphere of application: medicine, cardiology.
