Effects of ACE Inhibitors on Skeletal Muscle

Abstract

Angiotensin-converting enzyme (ACE) inhibitors reduce morbidity, mortality, hospital admissions, and decline in physical function and exercise capacity in congestive heart failure (CHF) patients. These therapeutic effects are attributed primarily to beneficial cardiovascular actions of these drugs. However, it has been suggested that ACE inhibitor-induced positive effects may also be mediated by direct action on the skeletal muscle. In particular, two recently published observational studies documented that among hypertensive subjects free of CHF, treatment with ACE inhibitors was associated with better performance and muscular outcomes and genetic studies also support the hypothesis that the ACE system may be involved in physical performance and skeletal muscle function. Effects on the skeletal muscle are probably mediated by mechanical, metabolic, anti-inflammatory, nutritional, neurological and angiogenetic actions of these drugs. These studies may have major public health implications for older adults, as consequence of the fact that, in this population, gradual loss of muscle mass and muscle strength can play a key role in the onset and progression of disability. Therefore, if findings of observational studies will be later confirmed in randomized controlled trials, ACE inhibitors could represent an effective intervention to prevent physical decline in the elderly, leading to greater autonomy in this growing population.

Oral Drugs Related with Muscle Wasting and Sarcopenia. A Review

“…The formation of angiotensin II mainly results in a vasoconstriction, catecholamine release and aldosterone secretion, mediated by receptors AT1. It has been suggested that beneficial effects of ACE inhibitors and angiotensin receptors blockers (ARBs) is due to this improved oxygen delivery [11] and by direct positive actions on the skeletal muscle [12,13] .…”

Muscle Injuries and Repair: What's New on the Horizon!

“…Investigators have also shown a relationship between the modulation of angiotensin II and skeletal muscle fibrosis. Patients treated with angiotensin-modulating medications for hypertension also displayed the unexpected side effect of decreased wasting and fatty infiltration of their skeletal muscle tissues [Onder et al, 2006]. In addition, elite endurance athletes appear to metabolize angiotensin II at an accelerated rate, leading to the decreased exposure of their muscles to the molecule thus maintaining high levels of muscle function [Onder et al, 2006].…”

“…Patients treated with angiotensin-modulating medications for hypertension also displayed the unexpected side effect of decreased wasting and fatty infiltration of their skeletal muscle tissues [Onder et al, 2006]. In addition, elite endurance athletes appear to metabolize angiotensin II at an accelerated rate, leading to the decreased exposure of their muscles to the molecule thus maintaining high levels of muscle function [Onder et al, 2006]. We have also observed an improvement in skeletal muscle healing after injury following treatment with an angiotensin II receptor blockade -a finding that correlates with the reduction in fibrosis and the enhancement of muscle regeneration [Bedair et al, 2008].…”

Sarcopenia: Pharmacology of Today and Tomorrow

“…A beneficial role in skeletal muscles (Onder et al, 2002(Onder et al, , 2006, including the prevention of sarcopenia (Sumukadas et al, 2006;Carter and Groban, 2008), has been suggested. It is interesting to note that benefits are more related to increased ability to exercise (Onder et al, 2006).…”

“…It is interesting to note that benefits are more related to increased ability to exercise (Onder et al, 2006). Are such effects related to improvement of cardiac function, or do ACE inhibitors (e.g., enalapril; Fig.…”