Abstract 037: Ace Inhibitor Use by Older Adults is Associated with Improved Functional Responses to Exercise

Abstract

Introduction: Functional status, assessed objectively by measures of physical performance, is a strong predictor of cardiovascular events in older adults. Angiotensin converting enzyme (ACE) inhibitors may further enhance the beneficial effects of exercise training on the functional status of older adults, but studies are lacking to confirm. The objective of this study was to assess the association of ACE inhibitor use with exercise-derived improvements in physical function among physically-limited older adults. Hypothesis: Older adults who used ACE inhibitors would have larger improvements in physical function in response to exercise than non-users. Methods: This study is a secondary analysis of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study. LIFE-P investigated the effects of 12-month interventions consisting of either structured physical activity or health education to promote successful aging on 424 adults aged 70-89 years at risk for becoming physically disabled. This analysis compared change in outcome measures at 6- and 12-months among participants who (1) did not use anti-hypertensive drugs, (2) used ACEi, and (3) used anti-hypertensive drugs excluding ACEi. The primary outcome measures were change in performance on a battery of short-duration mobility tasks (SPPB) and walking speed during a 400 meter test. Results: A significant medication by intervention interaction existed for SPPB (p=0.018). PA improved the adjusted SPPB score among ACEi users (p<0.001) and users of other anti-hypertensive drugs (p=0.005) but not among anti-hypertensive non-users (p=0.911). Adjusted SPPB changes at 12 months were 0.95 points among ACEi users, 0.77 points among users of other anti-hypertensive drugs, and -0.08 points among anti-hypertensive non-users. For walking speed, the medication by intervention interaction was not significant (p=0.178), but a trend existed for the medication by intervention by visit interaction (p=0.094). PA significantly improved the adjusted walking speed of ACEi users (p<0.001) but did not improve walking speed among the other two groups across study visits. At 12 months adjusted changes were 0.06 m/sec among ACEi users, 0.05 m/sec among anti-hypertensive non-users, and 0.02 m/sec among users of other anti-hypertensives. Conclusions: Among older adults at risk for disability, exercise-derived improvements in physical function were greatest among ACEi users. Future prospective studies are needed to confirm the true efficacy of ACE inhibitors in improving older adults’ functional responses to exercise.