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No Significant Treatment Effect with Angiotensin-Converting Enzyme Inhibitors (ACEi)

Age Ageing September 2013 EFFECT OF ACE INHIBITORS ON PHYSICAL FUNCTION IN OLDER PEOPLE UNDERGOING EXERCISE TRAININGIntroduction: The loss of muscle mass and function with ageing is a major cause for falls, disability and morbidity in older people. We have previously shown that angiotensin-converting enzyme inhibitors (ACEi) improve physical function in older people and evidence suggests that ACEi may potentially improve the response to exercise training. We therefore designed a study to examine the effects of ACEi therapy in older people undergoing exercise training.

Methods: In a double-blind trial, community-dwelling functionally impaired older people (age ≥65 years) were randomised to receive either 4 mg perindopril daily or matching placebo for 20 weeks. Additionally all participants received 20 weeks of exercise training (10 weeks of supervised hospital-based progressive resistance training followed by 10 weeks of unsupervised training). The primary outcome measure was 6 minute walk distance; secondary outcomes included Short physical performance battery, hand-grip and quadriceps strength, self-reported quality-of-life using the EuroQol-5D and the functional limitation profile.

Results: A total of 170 participants were randomised, mean age 75.7 (SD 6.8) years; 42% were male. Baseline 6-minute walk distance was 306 m (SD: 99). Both groups increased their walk distance (by 29.6 m in the exercise + ACEi group and 36.4 m in the exercise only group) at 20 weeks, but the treatment effect between groups was not statistically significant (between group difference at 20 weeks, 8.6 m (95% CI: −30.1, 12.9, P = 0.43). Short Physical Performance Battery scores improved by a similar amount in both groups (1.0 in the exercise + ACEi group, 1.1 in the exercise only group), with no significant treatment effect (between group difference at 20 weeks: −0.09, 95% CI: −0.74 to 0.57, P = 0.79). There were no significant treatment effects in any of the other outcome measures between groups.

Conclusion: ACEi for 20 weeks did not improve measures of physical function beyond that achieved by exercise training in functionally impaired older people.

You can read the full publication on the Age and Ageing website.

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