Treatment of hypertension in the elderly: Effects on blood pressure, heart rate, and physical fitness

Leonetti, Gastone; Mazzola, C; Pasotti, C; Angioni, Lucas; Vaccarella, A.; Capra, A.; Botta, Gianfranco; Zanchetti, Alberto

doi:10.1016/0002-9343(91)90429-2

Cited by 15 publications

(10 citation statements)

References 2 publications

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“…In another study comparing ACEi with nifedipine (mean age 75 years), no significant differences in physical performance was seen between the two groups (27). However, in a small study of 36 older men with hypertension, endurance increased in those receiving ACEi (28), and our previous randomized controlled trial in functionally impaired people showed that 20 weeks of ACEi treatment significantly improved 6MWD by 31.6 m compared with placebo and resulted in a clinically significant improvement in quality of life (6). In rodents, improvements in performance with ACEi in combination with exercise but not with ACEi alone have been reported (29), but the evidence is not consistent (30,31).…”

Section: Discussionmentioning

confidence: 99%

Do ACE Inhibitors Improve the Response to Exercise Training in Functionally Impaired Older Adults? A Randomized Controlled Trial

Sumukadas

Band

Miller³

et al. 2013

The Journals of Gerontology Series A: Biological Sciences and M

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Background.Loss of muscle mass and strength with ageing is a major cause for falls, disability, and morbidity in older people. Previous studies have found that angiotensin-converting enzyme inhibitors (ACEi) may improve physical function in older people. It is unclear whether ACEi provide additional benefit when added to a standard exercise training program. We examined the effects of ACEi therapy on physical function in older people undergoing exercise training.Methods.Community-dwelling people aged ≥65 years with functional impairment were recruited through general (family) practices. All participants received progressive exercise training. Participants were randomized to receive either 4 mg perindopril or matching placebo daily for 20 weeks. The primary outcome was between-group change in 6-minute walk distance from baseline to 20 weeks. Secondary outcomes included changes in Short Physical Performance Battery, handgrip and quadriceps strength, self-reported quality of life using the EQ-5D, and functional impairment measured using the Functional Limitations Profile.Results.A total of 170 participants (n = 86 perindopril, n = 84 placebo) were randomized. Mean age was 75.7 (standard deviation [SD] 6.8) years. Baseline 6-minute walk distance was 306 m (SD 99). Both groups increased their walk distance (by 29.6 m perindopril, 36.4 m placebo group) at 20 weeks, but there was no statistically significant treatment effect between groups (−8.6m [95% confidence interval: −30.1, 12.9], p = .43). No statistically significant treatment effects were observed between groups for the secondary outcomes. Adverse events leading to withdrawal were few (n = 0 perindopril, n = 4 placebo).Interpretation.ACE inhibitors did not enhance the effect of exercise training on physical function in functionally impaired older people.

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Section: Discussionmentioning

confidence: 99%

Do ACE Inhibitors Improve the Response to Exercise Training in Functionally Impaired Older Adults? A Randomized Controlled Trial

Sumukadas

Band

Miller³

et al. 2013

The Journals of Gerontology Series A: Biological Sciences and M

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“…ACE inhibitor use in a placebo controlled trial increased exercise time in older hypertensive men. {Leonetti, 1991 #601} In an epidemiological study, ACE inhibitor use was related to less decline in muscle strength and walking speed in older disabled women with hypertension compared to nonuse. {Onder, 2002 #2}, In contrast, ACE-inhibitor use was not associated with a lower risk for incident frailty, a construct which is characterized in part by mobility problems, in healthy postmenopausal women.…”

Section: Discussionmentioning

confidence: 99%

Angiotensin‐Converting Enzyme Inhibitor and Statin Use and Incident Mobility Limitation in Community‐Dwelling Older Adults: The Health, Aging and Body Composition Study

Gray

Boudreau²,

Newman³

et al. 2011

J American Geriatrics Society

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Objective Angiotensin-converting enzyme (ACE) inhibitors and statin medications have been proposed as potential agents to prevent or delay physical disability; yet limited research has evaluated whether such use in older community dwelling adults is associated with a lower risk of incident mobility limitation. Design Longitudinal cohort study Setting Health, Aging and Body Composition (Health ABC) Participants 3055 participants who were well functioning at baseline (e.g., no mobility limitations). Measurements Summated standardized daily doses (low, medium and high) and duration of ACE inhibitor and statin use was computed. Mobility limitation (two consecutive self-reports of having any difficulty walking 1/4 mile or climbing 10 steps without resting) was assessed every 6 months after baseline. Multivariable Cox proportional hazard analyses were conducted adjusting for demographics, health status, and health behaviors. Results At baseline, ACE inhibitors and statins were used by 15.2% and 12.9%, respectively and both increased to over 25% by year 6. Over 6.5 years of follow-up, 49.8% had developed mobility limitation. In separate multivariable models, neither ACE inhibitor (multivariate hazard ratio [HR] 0.95; 95% confidence interval [CI] 0.82–1.09) nor statin use (multivariate HR 1.02; 95% CI 0.87–1.17) was associated with a lower risk for mobility limitation. Similar findings were seen in analyses examining dose- and duration-response relationships and sensitivity analyses restricted to those with hypertension. Conclusions These findings indicate that ACE inhibitors and statins widely prescribed to treat hypertension and hypercholesterolemia, respectively do not lower risk of mobility limitation, an important life quality indicator.

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“…The medications used to control hypertension in patients in the CA + H group included angiotensin converting enzymes (ACE), beta blockers, and diuretics. The main hemodynamic effects of these drugs on the cardiovascular system would involve changes in cardiac debt, total peripheral resistance, and heart rate; with all of these drugs reducing total peripheral resistance, with no impact on cardiac debt or heart rate by ACE or diuretics (Leonetti et al, 1989(Leonetti et al, , 1991Onder et al, 2002). Therefore, these medications do not seem to have a significant impact on the performance of the CA + H group during the oxygen consumption test.…”

Section: Cardiorespiratory Fitness (Vo 2peak )mentioning

confidence: 93%

Cardiorespiratory Fitness and Quality-of-Life Analysis Posttreatment in Breast Cancer Survivors

Tolentino

Battaglini

Araújo

et al. 2010

Journal of Psychosocial Oncology

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This study compared VO(2peak), treatment frequency and dosage, and QOL between 22 post-treated breast cancer survivors (CATotal) and 22 apparently healthy, age-matched women (CO). The CATotal group included 11 with no history of any other co-morbidities (CA) and 11 with controlled hypertension (CA + H). VO(2peak) was measured using the Bruce Protocol. QOL was measured using the SF-36 survey. Significant differences were observed in VO(2peak) between CATotal and CO (p = 0.014), CA and CA + H (p = 0.001), and CA + H and CO (p = 0.001). Physical, emotional, and mental health domains of the SF-36 were significantly different between CATotal and CO (p = 0.006, 0.001, and 0.05 respectively). These results suggest that breast cancer survivors with controlled hypertension can experience a significant reduction in VO(2peak) when compared to apparently healthy, age-matched controls. Also, treatment frequency and dosage affected QOL in this group of survivors.

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Treatment of hypertension in the elderly: Effects on blood pressure, heart rate, and physical fitness

Cited by 15 publications

References 2 publications

Do ACE Inhibitors Improve the Response to Exercise Training in Functionally Impaired Older Adults? A Randomized Controlled Trial

Do ACE Inhibitors Improve the Response to Exercise Training in Functionally Impaired Older Adults? A Randomized Controlled Trial

Angiotensin‐Converting Enzyme Inhibitor and Statin Use and Incident Mobility Limitation in Community‐Dwelling Older Adults: The Health, Aging and Body Composition Study

Cardiorespiratory Fitness and Quality-of-Life Analysis Posttreatment in Breast Cancer Survivors

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