Angiotensin Converting Enzyme Inhibitors Combined with Exercise for Hypertensive Seniors (The ACES Trial): Study Protocol of a Randomized Controlled Trial

Abstract

Prior evidence suggests that the choice of antihypertensive medication may influence functional status among older adults with hypertension, particularly in conjunction with exercise. In particular, angiotensin converting enzyme (ACE) inhibitors have shown potential to positively influence function. However, randomized, controlled trials are needed to confirm this hypothesis. This paper outlines an RCT designed to determine if choice of first-line antihypertensive medication influences functional and cardiovascular risk factor responses to exercise among older adults with hypertension. Two hundred and thirteen inactive, community-dwelling adults ≥60 years of age with hypertension and functional limitations will be recruited to engage in a 32-week intervention study. Participants will be randomized to one of three first-line antihypertensive agents: (1) the ACE inhibitor perindopril, (2) the AT1 receptor antagonist losartan, or (3) the thiazide diuretic hydrochlorothiazide (HCTZ). Six weeks after randomization, participants will begin a 20-week structured aerobic exercise intervention. Participants will perform two 45-min center-based sessions coupled with 60 min of home-based walking per week. The primary aim is to determine if perindopril improves self-paced gait speed when compared with losartan and HCTZ. The secondary aim is to determine the relative effect of perindopril on secondary outcomes such as: (a) exercise capacity, (b) body mass and composition, and (c) circulating indices of cardiovascular risk. This RCT is expected to identify differential effects of first-line antihypertensive medications when combined with physical exercise thus have potential implications for antihypertensive prescription guidelines for older adults.

Advances in research on pharmacotherapy of sarcopenia

“…A subsequent RCT (NCT03295734, currently recruiting) is under the recruiting stage, in which 213 inactive, community‐dwelling adults aged 60 years or over with hypertension and functional limitations are engaged in a 32‐week study. The trial will compare drug effects on self‐paced gait speed, exercise capacity, body mass, and composition and circulating indices of cardiovascular risk 41 …”

“…The trial will compare drug effects on self‐paced gait speed, exercise capacity, body mass, and composition and circulating indices of cardiovascular risk. 41 …”

Effect of treatment with carvacrol and aerobic training on cardiovascular function in spontaneously hypertensive rats

“…The combination of aerobic training and medication is already acknowledged as having a positive effect in the treatment of SAH and other cardiovascular disorders (Harper et al, 2019;Maida et al, 2016).…”

“…The combination of aerobic training and medication is already acknowledged as having a positive effect in the treatment of SAH and other cardiovascular disorders (Harper et al., 2019; Maida et al., 2016). There is, however, a paucity of studies which assess aerobic training alongside the daily use of carvacrol orally to control SAH and reduce cardiovascular risk in spontaneously hypertensive animals.…”

Interactive Effects of Enalapril Administration and Novel HIIT Wheel-Bed Training in Aged Rats

“…Compared with placebo, enalapril significantly increased the walking tolerance after treatment (28). In addition, genetic, epidemiological, and clinical studies in older adults demonstrate that multi-modal interventions of exercise/physical activity and ACE inhibitors improve physical function (30)(31)(32)(33)(34). However, none of these studies have investigated the impact of HIIT in combination with ACE inhibitor treatment.…”