ACE Inhibitors May Delay Disability in Elderly Women

March 20, 2002

NEW YORK (MedscapeWire) Mar 21 — Although angiotensin-converting enzyme (ACE) inhibitors are known to improve exercise tolerance in patients with heart failure, this was initially thought to be related to improved cardiac function. Research reported in the March 16 issue of The Lancet now suggests that ACE inhibitors also reduce age-associated decline in muscle strength and function.

"This is one of the first studies to suggest that a drug treatment could delay a decline in physical function," lead author Graziano Onder, MD, from Wake Forest University Baptist Medical Center in Winston-Salem, North Carolina, says in a news release. "Our results indicate that ACE inhibitor drugs could slow the process that leads to disability."

In the Women's Health and Aging Study, 641 women with hypertension (average age, 79 years) were stratified into 4 groups depending on antihypertensive treatment: 61 had used ACE inhibitors continuously, 133 intermittently, 301 had used other antihypertensive drugs either continuously or intermittently, and 146 had never used antihypertensive drugs.

Over a 3-year period, average decline in knee-extensor muscle strength was 1 kg in women who used ACE inhibitors continuously, 3.7 kg in women who used other antihypertensive drugs continuously or intermittently, and 3.9 kg in women who had never used antihypertensive drugs.

Walking speed decreased by 1.7 cm per second in continuous users of ACE inhibitors, which was substantially less than the 13.6 cm per second decrease in intermittent users of ACE inhibitors, 15.7 cm per second in intermittent users of other antihypertensive drugs, and 17.9 cm per second in women who did not use antihypertensive drugs at all.

"The finding that medication use is associated with maintenance of walking ability in a group of partially disabled women is exciting," said Richard Havlik, MD, MPH, from the NIA. "If the result is replicated in further research it could lead to a valuable intervention."

As declines in walking speed and muscle strength have been shown to predict the onset of disability, mortality, and nursing home and hospital admission in older adults, these results may have considerable practical implications.

"The effect needs to be confirmed by additional research," Onder says. "But it points to the possibility of ACE inhibitors being used as a first-line therapy for hypertension in older adults. Currently, these drugs are recommended only in certain situations."

Onder's group is planning similar trials in men.

Lancet. 2002;359(9310):926-930

Reviewed by Gary D. Vogin, MD

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