ACES - ACE inhibitors Combined with Exercise for hypertensive Seniors

ACES - ACE 抑制剂与运动相结合治疗高血压老年人

• 批准号: 10228615
• 负责人: Thomas W Buford
• 金额: $ 56.26万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10228615
• 关键词: Adjuvant; Aerobic Exercise; Age-Years; American; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Attenuated; Biopsy; Blood Pressure; Blood capillaries; Cardiac Surgery procedures; Cardiovascular system; Cessation of life; Cholesterol; Chronic; Cities; Clinical; Clinical Practice Guideline; Data; Dose; Drug Prescriptions; Dual-Energy X-Ray Absorptiometry; E-Selectin; Elderly; Endocrine; Epidemiology; Event; Exercise; FDA approved; Gait speed; Geography; Glucose; Heart; Hydrochlorothiazide; Hypertension; Individual; Inflammation; Interleukin-6; Intervention; Intervention Studies; Life Style; Losartan; Masks; Measures; Messenger RNA; Muscle; Muscle Fibers; Outcome; Oxidative Regulation; Oxidative Stress; Participant; Perindopril; Pharmaceutical Preparations; Pharmacology; Phase; Physical Exercise; Physical Performance; Physiological; Population; Proteins; Protocols documentation; Randomized; Randomized Controlled Trials; Renin-Angiotensin System; Reporting; Risk; Risk Reduction; Signal Transduction; Site; Skeletal Muscle; Structure; TNF gene; Target Populations; Testing; Thiazide Diuretics; Vascular Cell Adhesion Molecule-1; Walking; Woman; angiogenesis; base; blood pressure regulation; cardiovascular health; cardiovascular risk factor; clinical practice; clinically relevant; clinically significant; disability; exercise capacity; exercise intervention; exercise program; exercise training; experience; functional decline; functional improvement; functional outcomes; functional status; high risk; high risk population; improved; indexing; member; men; normotensive; oxidized low density lipoprotein; peer; pre-clinical; preservation; prevent; primary outcome; public health priorities; public health relevance; receptor; recruit; response; safety and feasibility; secondary outcome; sedentary; surgical risk; systemic inflammatory response; vascular inflammation; walking speed

ABSTRACT The purpose of this project is to conduct a randomized, controlled trial (RCT) to determine if choice of antihypertensive medication influences changes in functional status and other cardiovascular risk factors among older persons with hypertension. Functional status, determined by measures of physical performance, is an important predictor of cardiovascular outcomes in older adults. Seniors with compromised function experience more CV events, have a higher risk of undergoing cardiac surgery and higher risk of CVD-related death than higher-functioning peers. Seniors with hypertension experience accelerated declines in function, and presently physical exercise is the primary strategy for preventing this decline. However, functional responses to exercise are highly variable and appear to be influenced by the type of antihypertensive medication(s) utilized to control blood pressure. Preliminary evidence suggests that, compared to other first- line antihypertensive agents, angiotensin converting enzyme (ACE) inhibitors enhance exercise-derived improvements in functional status among hypertensive seniors. This RCT will test this hypothesis. Sedentary men and women > 65 years of age with functional limitations and hypertension will be recruited from two sites to participate in a 36 week intervention study. Participants will be randomly assigned to one of three first-line antihypertensive agents: (1) the ACE inhibitor perindopril, (2) AT1 receptor antagonist losartan, or (3) the thiazide diuretic hydrochlorothiazide. All participants will also participate in a structured aerobic exercise intervention. The primary aim is to determine if, compared to losartan and HCTZ, perindopril improves self- paced gait speed. The secondary aim is to determine the relative effect of perindopril on a) exercise capacity, b) body mass and composition, and c) circulating indices of cardiovascular risk. In exploratory analyses, skeletal muscle biopsies will be collected to evaluate the influence of study drugs on indices of skeletal muscle angiogenesis. This study is expected to differentiate beneficial effects of three FDA-approved antihypertensive medications on an emerging cardiovascular risk factor in a clinically-relevant population. Thus the study has important implications for expeditiously influencing clinical practice guidelines in the prescription of antihypertensive drugs to millions of Americans.

抽象的 该项目的目的是进行随机，对照试验（RCT），以确定是否选择 降压药影响功能状况和其他心血管危险因素的变化 在患有高血压的老年人中。功能状态，由身体绩效的度量确定， 是老年人心血管结局的重要预测指标。职能妥协的老年人 体验更多的简历活动，接受心脏手术的风险更高，并且与CVD相关的风险更高 死亡比高功能的同龄人。具有高血压经验的老年人的功能下降， 目前，体育锻炼是防止这种下降的主要策略。但是，功能性 对运动的反应高度可变，并且似乎受到降压类型的影响 用于控制血压的药物。初步证据表明，与其他先前 线降压药，血管紧张素转化酶（ACE）抑制剂增强运动衍生 高血压老年人的功能状况改善。该RCT将检验该假设。久坐 男性和女人> 65岁，功能限制和高血压将从两个地点招募 参加36周的干预研究。参与者将被随机分配给三个一线之一 降压药：（1）ACE抑制剂Perindopril，（2）AT1受体拮抗剂Losartan，或（3） 噻嗪类利尿氢氯噻嗪。所有参与者还将参加结构化的有氧运动 干涉。主要目的是确定与Losartan和HCTZ相比，Perindopril是否改善了自我 步调步态速度。次要目的是确定perindopril对a）锻炼能力的相对影响， b）体重和成分，以及c）心血管风险的循环指标。在探索性分析中 将收集骨骼肌活检以评估研究药物对骨骼肌指标的影响 血管生成。预计这项研究将区分三个FDA批准的抗高血压的有益作用 与临床相关的人群中新兴心血管危险因素的药物。因此该研究具有 在处方中迅速影响临床实践指南的重要意义 数百万美国人的降压药。