Abstract
ObjectivePreclinical and observational data suggest that angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may be able to improve physical performance in older people via direct and indirect effects on skeletal muscle. We aimed to summarize current evidence from randomised controlled trials in this area. DesignSystematic review and meta-analysis. Setting and ParticipantsRandomized controlled trials enrolling older people, comparing ACEi or ARB to placebo, usual care or another antihypertensive agent, with outcome data on measures of physical performance. MethodsWe searched multiple electronic databases without language restriction between inception and the end of February 2020. Trials were excluded if the mean age of participants was <65 years or treatment was targeting specific diseases known to affect muscle function (for example heart failure). Data were sought on measures of endurance and strength. Standardized mean difference (SMD) treatment effects were calculated using random-effects models with RevMan software. ResultsEight trials (952 participants) were included. Six trials tested ACEi, 2 trials tested ARBs. The mean age of participants ranged from 66 to 79 years, and the duration of treatment ranged from 2 months to 1 year. Trials recruited healthy older people and people with functional impairment; no trials specifically targeted older people with sarcopenia. Risk of bias for all trials was low to moderate. No significant effect was seen on endurance outcomes [6 trials, SMD 0.04 (95% CI –0.22 to 0.29); P = .77; I2 = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I2 = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I2 = 0%]. No evidence of publication bias was evident on inspection of funnel plots. Conclusions and ImplicationsExisting evidence does not support the use of ACE inhibitors or angiotensin receptor blockers as a single intervention to improve physical performance in older people.
Highlights
ObjectivePreclinical and observational data suggest that angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may be able to improve physical performance in older people via direct and indirect effects on skeletal muscle
Existing evidence does not support the use of ACEi or ARBs as stand-alone therapies to improve physical performance in older people, either with or without a diagnosis of sarcopenia
Further research in this area should focus on people with a diagnosis of sarcopenia made using contemporary criteria such as those recommended by the European Working Group on Sarcopenia.[40]
Summary
Preclinical and observational data suggest that angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may be able to improve physical performance in older people via direct and indirect effects on skeletal muscle. Setting and Participants: Randomized controlled trials enrolling older people, comparing ACEi or ARB to placebo, usual care or another antihypertensive agent, with outcome data on measures of physical performance. Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are classes of medication that work by either inhibiting production of angiotensin II or blocking the effect of angiotensin II at the AT1 receptor They have a number of beneficial effects on cardiovascular physiology including improved endothelial function, reduced myocardial fibrosis, regression of left ventricular hypertrophy, and improvement of left ventricular systolic function. A number of other studies have been published The aim of this analysis was, to conduct an up-to-date and thorough systematic review of the effect of ACE inhibitors and angiotensin receptor blockers on both endurance and strength performance in older people.
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