Tuesday, October 09, 2007

ACE inhibitors back in mobility news

I just read an interesting item about ACE inhibitors, a class of drugs used to treat hypertension, heart failure, and also known to help prevent kidney disease in diabetics.

Previous research suggested that ACEIs (such as lisinopril, enalopril, Altace, etc.) may provide a boost to aging muscles as well as to the heart. Over 600 women participating in the Women's Health and Aging Study were sorted into groups based on the type of blood pressure medication they were on. Over the three years of the study, those subjects on ACE inhibitors had significantly less loss of quadriceps muscle strength and far less decline in walking speed.*

The latest study was conducted by Deepa Sumukadas, M.D., of the University of Dundee, and colleagues (1). The researchers randomized 130 oldsters--all of whom had mobility problems--to receive an ACEI called perindopril or placebo over the course of 5 months. Those in the real deal group displayed improvement equivalent to six months of exercise training, motoring 31.4 meters further in six minutes than the control group. Perhaps creeping is more the operative word here than motoring, but those extra meters crept represented significantly more mobility.

Ann Cranney, M.D., of the Ottawa Health Research Institute had this to say, "Their results are promising and lend support to the hypothesis that ACE inhibition has a positive effect on physical function, possibly through effects on skeletal muscle."

Well why not, I'll see if a course of ACEIs brings back the fidgets to my immobile old mom.
*Diminished walking speed and muscle strength have been shown to predict the onset of disability, and worse--nursing home admissions and death--in older adults.

(1) Sumukadas D et al. "Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial." CMAJ 2007;177(8):867-74.


Mauigirl said...

Very interesting. I believe my aunt's blood pressure drug is an ACE inhibitor; it would be a good thing if it may be helping her mobility. She was getting a bit unsteady in her walking before. Perhaps this is helping her in that regard. She only went on it a few months ago.

KGMom said...

I have moderate HBP, but am being very successfully controlled with beta blockers.

Femail doc said...

MG: I'll be interested to here if late life ACE inhibitors actually make a noticeable difference in an unsteady old lady, and not just a boost that looks good in a research paper.

KGM: There is increasingly feeling that beta blockers are no longer a great choice for hypertension uncomplicated by heart failure. While they effectively lower pressure, the important outcomes--such as incidence of stroke and heart attack--are better with other choices.

I have prescribed beta blockers a lot in the past, and am pondering whether it's time to change lots of people over to other things such as ACE inhibitors, diuretics, and calcium channel blockers.