Key result
The ACES trial is a planned randomized controlled trial that will evaluate whether the ACE inhibitor perindopril improves self-paced gait speed compared to losartan and hydrochlorothiazide when combined with exercise in older adults with hypertension.
Why the study?
Antihypertensive medication choice may influence functional status in older adults with hypertension, particularly with exercise, but randomized controlled trials are needed to confirm whether ACE inhibitors positively influence function.
Does perindopril improve self-paced gait speed compared to losartan or hydrochlorothiazide when combined with exercise in older adults with hypertension and functional limitations?
RCT (n=213)
Triple-masked
Block randomization, stratified by site, age, and cough history
Yes
Does perindopril improve self-paced gait speed compared to losartan or hydrochlorothiazide when combined with exercise in older adults with hypertension and functional limitations?
This study protocol outlines a randomized controlled trial to determine if the choice of first-line antihypertensive medication (perindopril vs. losartan vs. hydrochlorothiazide) influences functional and cardiovascular risk factor responses to exercise in older adults.
May inform antihypertensive choice to preserve mobility in older adults; leaves open optimal regimen when combined with exercise.
Prior evidence suggests that the choice of antihypertensive medication may influence functional status among older adults with hypertension, particularly in conjunction with exercise. In particular, angiotensin converting enzyme (ACE) inhibitors have shown potential to positively influence function. However, randomized, controlled trials are needed to confirm this hypothesis. This paper outlines an RCT designed to determine if choice of first-line antihypertensive medication influences functional and cardiovascular risk factor responses to exercise among older adults with hypertension. Two hundred thirteen inactive, community-dwelling adults ≥ 60 years of age with hypertension and functional limitations will be recruited to engage in a 32-week intervention study. Participants will be randomized to one of three first-line antihypertensive agents: (1) the ACE inhibitor perindopril, (2) the AT1 receptor antagonist losartan, or (3) the thiazide diuretic hydrochlorothiazide (HCTZ). Six weeks after randomization, participants will begin a 20-week structured aerobic exercise intervention. Participants will perform two 45-minute center-based sessions coupled with 60 minutes of home-based walking per week. The primary aim is to determine if perindopril improves self-paced gait speed when compared with losartan and HCTZ. The secondary aim is to determine the relative effect of perindopril on secondary outcomes such as: a) exercise capacity, b) body mass and composition, and c) circulating indices of cardiovascular risk. This RCT is expected to identify differential effects of first-line antihypertensive medications when combined with physical exercise thus have potential implications for antihypertensive prescription guidelines for older adults.
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Harper et al. (2020) conducted an RCT in Hypertension and functional limitations (n=213). Perindopril combined with exercise vs. Losartan (50 to 100 mg/day) or Hydrochlorothiazide (12.5 to 25 mg/day) combined with exercise was evaluated on Change in usual-pace walking speed, measured over a 4 m course from week 6 to 26. The ACES trial is a planned randomized controlled trial that will evaluate whether the ACE inhibitor perindopril improves self-paced gait speed compared to losartan and hydrochlorothiazide when combined with exercise in older adults with hypertension.
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