Objectives
Aim of the present study was to evaluate whether an ACE inhibitor intervention is
able to significantly improve physical performance and muscle strength in a sample
of older persons.
Design
Double-blind, cross-over, randomized, placebo-controlled trial.
Setting
The Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk
Factors (TRAIN) study.
Participants
Participants were 257 subjects aged 55 years and older with high cardiovascular risk
profile.
Intervention
Six months of fosinopril use versus placebo.
Measurements
The Short Physical Performance Battery score (rescaled to obtain a continuous variable
ranging from 0 to 3 points), and the hand grip strength were measured at the baseline
visit, and after 6 and 12 months of follow-up. Paired t test analyses were performed to compare results of physical function measures after
ACE inhibition and placebo interventions.
Results
Mean age of the sample population was 65.97 (standard deviation 7.41) years old. No
statistically significant difference was found at the Short Physical Performance Battery
(P=.23) and hand grip strength (P=.57) results after ACE inhibition (2.113, standard deviation [SD] 0.284; and 37.044 kg, SD 12.993 kg, respectively) compared to placebo (2.096, SD 0.298; and 36.898 kg, SD 13.178 kg, respectively). No significant effects from ACE inhibition were also found when
the 3 subtests composing the Short Physical Performance Battery (ie, 4-meter walking
speed, balance, and chair stand tests) were separately analyzed. Consistent negative
results were obtained after analyses were restricted to participants showing the highest
compliance to treatment and/or receiving the maximum fosinopril dosage.
Conclusion
No significant modifications in physical performance and muscle strength were reported
after 6 months of fosinopril use in older persons with high cardiovascular risk profile.
Given these negative findings, it is possible that the beneficial effects of ACE inhibitors
on physical function might be attributable to the activation of a virtuous cycle determined
by an improved cardiovascular system. Further specifically designed studies are needed
to confirm our findings, and expand them to different populations and ACE inhibitors.
If our findings will be confirmed, the extracardiovascular properties of ACE inhibitors
in older persons might be substantially resized.
Keywords
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Article info
Publication history
Published online: November 26, 2009
Footnotes
The TRAIN study was funded by the National Institutes of Health (NIH grant R01-HL68901). The TRAIN study was also (partially) supported by the University of Florida Claude D. Pepper Older Americans Independence Center (NIH grant 1P30-AG028740), Wake Forest University Claude D. Pepper Older Americans Independence Center (NIH grant 5P30-AG021332), and the Wake Forest University General Clinical Research Center (NIH grant M01-RR07122). Fosinopril was donated by Bristol-Myers Squibb (New York, NY).
Identification
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© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
