Objective: Evidence shows that an elevated pulse pressure (PP) may lead to an increased risk of cardiovascular morbidity and mortality. The aim of the present study was to determine the effects of polymorphism of the angiotensin-converting enzyme (ACE) gene on the PP after a first anterior acute myocardial infarction (AMI). Methods: Overall 116 patients with a first anterior AMI were included in this cross-sectional study. DNA was isolated from peripheral leukocytes. The ID status was determined by polymerase chain reaction by a laboratory staff member who was unaware of the clinical details. Based on the polymorphism of the ACE gene, they were classified into 3 groups: Deletion/Deletion (DD) genotype (Group 1, n=45), Insertion/Deletion (ID) genotype (Group 2, n=58), Insertion/Insertion (II) genotype (Group 3, n=13). Blood pressure measurements were performed in all patients within 10 minutes admitted to coronary care unit. The PP was calculated by subtraction of diastolic blood pressure (DBP) from systolic blood pressure (SBP). Echocardiographic examinations were performed using the parasternal longitudinal axis and apical 4-chamber windows in accordance with the recommendations of the American Echocardiography Committee. One-way analysis of variance (ANOVA) and Chi-square analyses were used to compare differences among subjects with different genotypes. Results: There were no significant differences among clinical parameters of patients. Pulse pressure was significantly higher in patients who have ACE DD and ID genotypes than in patients who have ACE II genotype (47±16, 47±14 and 39±12, F=3.4, p<0.05). But SBP, DBP and heart rate were not significantly different among ACE DD, ACE ID and ACE II genotypes. Conclusion: Our results suggested that, ACE Gene I/D polymorphism D allele may affect PP in patients with a first anterior AMI.