ACE Gene Variants: Blood Pressure, Heart Health, Endurance

Last reviewed: May 12, 2026 Last updated: May 12, 2026

Written by: Jay Hastings , CEO of PlexusDx

Jay Hastings is the CEO of PlexusDx, a precision health company focused on genetic testing, blood biomarker insights, and personalized wellness recommendations. He has more than 20 years of experience across healthcare innovation, genomics, laboratory operations, healthcare investing, and strategic finance. His work has included scaling healthcare startups, leading CLIA lab integrations, and helping expand consumer access to precision health tools.

Medically reviewed by: Jayden Lee, PharmD, EMBA

Jayden Lee, PharmD, EMBA, is the PlexusDx Medical Science Liaison with a PharmD and MBA specializing in pharmacogenomics and clinical product development, with a proven ability to bridge the gap between genomic research and practical patient outcomes. Dr. Lee has more than 10 years of professional experience in clinical pharmacy, academia, and research.

This article is part of the PlexusDx Education Hub — your resource for evidence-based guidance on heart & cardiovascular health. Browse all Heart & Cardiovascular Health education

Few genes tie together heart health and athletic performance as directly as ACE, the gene for angiotensin-converting enzyme. ACE is a central player in the renin-angiotensin system, the body's main hormonal circuit for regulating blood pressure, fluid balance, and vascular tone. A common variation in this gene has been studied for decades in the context of blood pressure, cardiac structure, and endurance capacity.

Understanding your ACE biology offers educational context — not a diagnosis and not a training prescription — about tendencies that interact with lifestyle, conditioning, and clinical care.

What ACE Does in the Body

Angiotensin-converting enzyme converts angiotensin I into angiotensin II, a potent hormone that narrows blood vessels and raises blood pressure, while also breaking down bradykinin, a molecule that relaxes vessels. In short, ACE activity tilts the balance toward vasoconstriction. This is precisely why a major class of blood pressure medications works by inhibiting this enzyme — a testament to how central ACE is to cardiovascular regulation.

The ACE Insertion/Deletion (I/D) Polymorphism

The most-studied ACE variant is the insertion/deletion (I/D) polymorphism (rs4646994 / rs1799752) in intron 16 of the gene. It comes in three genotypes: II, ID, and DD. The key finding is that the D (deletion) allele is associated with higher circulating and tissue ACE activity, while the I (insertion) allele is associated with lower activity. Because ACE activity influences angiotensin II levels, this single variant has been linked to differences in blood pressure regulation, cardiac remodeling, and exercise physiology.

ACE and Blood Pressure and Heart Health

Higher ACE activity in D-allele carriers has been associated in various studies with a tendency toward higher blood pressure and, in some populations, greater left-ventricular growth in response to stress or exercise. The evidence is not uniform across every group — blood pressure is influenced by many genes, diet, sodium intake, weight, and stress — but ACE is one recurring genetic contributor. This is why heart-healthy habits like managing sodium, staying active, and maintaining a healthy weight matter for everyone, and can be especially meaningful for those with a genetic lean toward higher ACE activity.

ACE and Endurance and Athletic Performance

The ACE gene earned fame in sports science because the I allele has been associated with endurance performance. Early studies of elite mountaineers and rowers found the I allele more frequently among high-altitude climbers and endurance athletes, while the D allele appeared more often in power and sprint athletes. The proposed mechanism involves more efficient cardiovascular and muscle-energy responses. The effect is modest and works alongside genes like ACTN3, but it remains one of the classic examples of a gene linked to human performance.

What Pathway-Level Genetics Reveals

The PlexusDx Precision Peptide Genetic Test analyzes 14 pathways, 49 peptides, 150+ genetic insights, including variants that intersect with cardiovascular and performance pathways. It provides pathway-level context about your biology — not a diagnosis of hypertension, not a treatment plan, and not a prediction of how you will respond to any medication. Knowing your baseline tendencies can inform a more productive conversation with a qualified provider about blood pressure, heart health, and training — with the decisions always resting with you and your clinician.

Frequently Asked Questions

What does the ACE gene do?

ACE encodes angiotensin-converting enzyme, which raises blood pressure by producing angiotensin II and breaking down the vessel-relaxing molecule bradykinin. It is central to the renin-angiotensin system that regulates blood pressure and fluid balance, which is why a major class of blood pressure medications targets this enzyme directly.

Is the ACE D allele bad for my heart?

Not necessarily. The D allele is linked to higher ACE activity and, in some studies, a tendency toward higher blood pressure or cardiac remodeling. But blood pressure reflects many genes and lifestyle factors. The D allele is a tendency, not a verdict, and heart-healthy habits benefit every genotype.

Does the ACE gene really affect athletic performance?

Research links the ACE I allele to endurance performance and the D allele to power and sprint tendencies, based on studies of elite athletes. The effect is modest and works alongside genes like ACTN3, training, and conditioning. ACE genetics is one influence among many, not a performance guarantee.

Can genetic testing predict my response to blood pressure medication?

No. The Precision Peptide Genetic Test provides pathway-level context about your biology and does not predict how you will respond to any medication. It is not a pharmacogenomic test. Medication decisions, including for blood pressure, belong to a qualified healthcare provider who evaluates your full clinical picture.

Curious how your cardiovascular and performance pathways are wired? Take the Precision Peptide Genetic Test to explore your pathway-level genetics and bring that context to your next provider conversation.

The Precision Peptide Genetic Test analyzes how your genes influence peptide-related biological pathways. It does not recommend, prescribe, or determine which peptides you should use. Consult a qualified healthcare provider before beginning any peptide protocol.

This article is part of the PlexusDx Education Hub. Browse all Heart & Cardiovascular Health education

Medical and Editorial Standards

Medical review process: This article was reviewed for medical accuracy, scientific clarity, evidence alignment, and appropriate discussion of genetics, medications, supplements, biomarkers, and health-related claims.

Sources and evidence: PlexusDx educational content is developed using peer-reviewed research, clinical literature, reputable medical references, and, where applicable, public health or regulatory guidance. References are included at the end of the article when scientific, medical, or health-related claims are discussed.

Commercial transparency: PlexusDx offers genetic testing, blood biomarker testing, personalized supplement recommendations, and related precision wellness services. Product mentions are intended to help readers understand available options and should not be interpreted as medical advice.

Important disclaimer: PlexusDx educational content is for informational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions about medications, supplements, genetic testing, lab testing, or health-related care.