中文摘要：

目的：探讨性别差异对不同血管紧张素转换酶（ACE）基因型高血压患者服用氢氯噻嗪后血清肾素-血管紧张素-醛固酮系统（RAAS）活性变化的影响。方法：根据自愿原则，随机纳入829例轻、中度高血压患者。所有患者均停服原有的抗高血压药物，并经过2周的安慰剂清洗期，随后口服氢氯噻嗪12．5mg，qd，连续服药6周。分析不同性别、ACE基因型患者服用氢氯噻嗪后血清RAAS水平的变化及二者之间的交互作用。结果：共776例研究对象完成了研究并纳入分析。DD基因型男性患者服用氢氯噻嗪6周后血清ACE和血管紧张素Ⅱ（AngⅡ）水平升高幅度均高于Ⅱ、ID基因型男性患者（P〈0．05）；而在女性中，DD基因型患者血清ACE和AngⅡ水平升高幅度却明显低于Ⅱ、ID基因型女性患者（P〈0．05）。性别与ACE基因插入／缺失（I／D）多态性对服用氢氯噻嗪后血清ACE水平变化存在明显交互作用（尸=0．032），对血清AngⅡ水平变化存在临界交互作用（P=0．070）。结论：校正年龄、体重指数和基线血压水平后，性别与ACE基因I／D多态性对服用氢氯噻嗪后血清ACE水平变化存在明显交互作用。

英文摘要：

OBJECTIVE： To evaluate effects of gender difference on renin angiotensin aldosterone system （RAAS） in response to bydrochlorothiazide （HCTZ） in hypertensive patients with different angiotensin converting enzyme （ACE） genotypes. METHODS： We enrolled randomly 829 mild/moderate hypertensive patients. All subjects stop taking previous antihypertensive drugs. Af- ter 2 weeks of wash-out period with placebo, every subject had been orally given 12.5 mg HCTZ, once a day for next 6 weeks. The activity of RAAS was determined after treatment. The interaction between genotypes at ACE I/D polymorphism and gender was analyzed. RESULTS： A total of 776 patients completed the study. In male, the increases of serum ACE and Ang Ⅱ activity in pa- tients with DD genotype after HCTZ were greater than those in patients with Ⅱ and ID genotypes （P〈0.05）. However, in female, the increases of serum ACE and Ang Ⅱ activity in patients with DD genotype after HCTZ were lower than those in patients with II and ID genotypes （P〈0.05）. There was statistically significant interaction of ACE gene I/D polymorphism and gender with changes of serum ACE activity （P=0.032）, and the marginal interaction between the effects of them and changes of serum Ang Ⅱ activity （P=0.070）. CONCLUSION： There was statistically significant interaction of ACE gene I/D polymorphism and gender with changes of serum ACE activity after adjusting age, BMI, and baseline blood pressure.