Location: Jean Mayer Human Nutrition Research Center On AgingTitle: Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on response to a physical activity intervention in older adults: results from the Lifestyle Interventions for Elders study
|BROWN, JOSHUA - University Of Florida|
|SMITH, STEVEN - University Of Florida|
|STROTMEYER, ELSA - University Of Pittsburgh|
|KRITCHEVSKY, STEPHEN - Wake Forest University|
|GILL, THOMAS - Yale University|
|BLAIR, STEVEN - University Of South Carolina|
|FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
|BUFORD, THOMAS - University Of Alabama|
|PAHOR, MARCO - University Of Florida|
|MANINI, TODD - University Of Florida|
Submitted to: Journals of Gerontology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/5/2019
Publication Date: 5/9/2019
Citation: Brown, J.D., Smith, S.M., Strotmeyer, E.S., Kritchevsky, S.B., Gill, T.M., Blair, S.N., Fielding, R.A., Buford, T.W., Pahor, M., Manini, T.M. 2019. Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on response to a physical activity intervention in older adults: results from the Lifestyle Interventions for Elders study. Journals of Gerontology. https://doi.org/10.1093/gerona/glz120.
Interpretive Summary: Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are medicines that are typically prescribed to lower blood pressure. However, there is emerging evidence that they may protect older people against aging-related declines in physical function and mobility. This study directly compared the use of these medicines (ACEis and ARBs) on the risk of developing mobility disability in older adults in conjunction with a regular program of physical activity. Using data from the Lifestyle Interventions for Elders (LIFE) trial which studied people age 70-89 years who were assigned to a physical activity (PA) or health education (HE) program and followed for approximately 2 years. Of 1,635 participants in the LIFE study, 796 used either an ACEi (496, 62.3%) or ARB (300, 37.7%). Compared to ACEi users, ARB users had a significantly lower risk of becoming physically disabled. These results suggest there may be a link between ARB use and prevention of age-related mobility disability.
Technical Abstract: Background: Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) may protect against aging-related decline. This study directly compared ACEis and ARBs on associations with risk of mobility disability in older adults when combined with a physical activity intervention. Methods: This was a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) trial. Participants aged 70-89 years were randomized to a physical activity or health education intervention. Outcomes included incident and persistent major mobility disability, injurious falls, short physical performance battery, and gait speed. For this analysis, only participants who reported ACEi or ARB use at baseline were included. Baseline differences between ACEi and ARB groups were adjusted for using inverse probability of treatment weights. Weighted Cox proportional hazard models and analysis of covariance models were used to evaluate the independent effects of medications and interaction effects with the intervention on each outcome. Results: Of 1,635 participants in the Lifestyle Interventions and Independence for Elders study, 796 used either an ACEi (496, 62.3%) or ARB (300, 37.7%). Compared with ACEi users, ARB users had 28% lower risk (hazard ratio [HR] = 0.72 [0.60-0.85]) of incident major mobility disability and 35% (HR = 0.65 [0.52-0.82]) lower risk of persistent major mobility disability whereas no interaction between medication use and intervention was observed. Risk of injurious falls and changes in short physical performance battery or gait speed were not different between ARB and ACEi users. Conclusions: These results suggest that ARBs may protect from major mobility disability by other mechanisms than improving physical performance.