Key result
Centrally-acting ACE inhibitors were associated with a significantly higher peak expiratory flow rate (adjusted difference 26.5 L/min) compared to peripherally-acting agents in older adults.
Why the study?
Evidence regarding ACE inhibitors and physical function is conflicting, which may be due to differential effects between centrally and peripherally acting subtypes categorized by their ability to cross the blood-brain barrier.
Does the use of centrally-acting ACE inhibitors improve physical performance measures compared to peripherally-acting ACE inhibitors in older adults?
Cross-Sectional (n=364)
Yes
Does the use of centrally-acting ACE inhibitors improve physical performance measures compared to peripherally-acting ACE inhibitors in older adults?
Centrally-acting ACE inhibitors are associated with better lung function (peak expiratory flow) compared to peripherally-acting ACE inhibitors in older adults, suggesting potential differential effects on physical performance.
Should not alter ACEI selection for function; leaves open whether central activity explains mixed prior ACEI-physical performance data.
BACKGROUND: There is conflicting evidence regarding the role of angiotensin-converting enzyme inhibitors and physical function. While some studies show improvements in muscle strength and physical function, others show no significant difference or decreased performance. This ambiguity could be due to differential effects of angiotensin-converting enzyme inhibitor subtypes which can be categorized as centrally or peripherally-acting based upon their ability to cross the blood-brain barrier. OBJECTIVE: The objective of this study is to compare physical performance measures among angiotensin-converting enzyme inhibitor subtype users. METHODS: Design: Cross-sectional Setting: Ambulatory Participants: Performed in 364 participants in the Health and Retirement Study cohort who were ≥ 65 years (median age (IQR) 74.00 (69-80) years. MEASUREMENTS: Average difference in hand grip (kg), gait speed(m/s) and peak expiratory flow (L/min). RESULTS: Compared to participants on a peripherally-acting angiotensin-converting enzyme inhibitor (113 (31%)), those on a centrally-acting agent (251(69%)) had stronger grip strength 28.9 ±1.0 vs 26.3±1.0, p=.011 and higher peak expiratory flow rates 316.8±130.4 vs. 280.0±118.5, p= .011 in unadjusted analysis. After multiple adjustments the difference in PEF remained statistically significant (Estimate(CI) 26.5, 95% CI 2.24, 50.5, p = 0.032). CONCLUSION: Our results suggest that in older adults the use of centrally-acting angiotensin-converting enzyme inhibitors compared to a peripherally acting angiotensin-converting enzyme inhibitors was associated with better lung function in older individuals.
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George et al. (2023) conducted a cross-sectional in Older adults on ACE inhibitors (n=364). Centrally-acting angiotensin-converting enzyme inhibitors vs. Peripherally-acting angiotensin-converting enzyme inhibitors was evaluated on Peak expiratory flow (PEF) rate (MD 26.5, 95% CI 2.24-50.5, p=0.032). Centrally-acting ACE inhibitors were associated with a significantly higher peak expiratory flow rate (adjusted difference 26.5 L/min) compared to peripherally-acting agents in older adults.
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