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: 9980747
• 负责人: Thomas W Buford
• 金额: $ 57.31万
• 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 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980747
• 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; 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一项随机对照试验 (RCT)，以确定是否选择 抗高血压药物会影响功能状态和其他心血管危险因素的变化 患有高血压的老年人中。功能状态，由身体表现测量确定， 是老年人心血管结局的重要预测因素。功能受损的老年人 经历更多的心血管事件、接受心脏手术的风险更高以及心血管疾病相关的风险更高 死亡人数高于功能较高的同龄人。患有高血压的老年人会经历功能加速衰退， 目前，体育锻炼是防止这种下降的主要策略。然而，功能性 对运动的反应差异很大，并且似乎受到抗高血压药物类型的影响 用于控制血压的药物。初步证据表明，与其他第一 一线抗高血压药、血管紧张素转换酶（ACE）抑制剂增强运动源性 高血压老年人的功能状态得到改善。该随机对照试验将检验这一假设。久坐 将从两个地点招募年龄 > 65 岁、患有功能限制和高血压的男性和女性 参加一项为期 36 周的干预研究。参与者将被随机分配到三个一线人员之一 抗高血压药物：(1) ACE 抑制剂培哚普利，(2) AT1 受体拮抗剂氯沙坦，或 (3) 噻嗪类利尿剂氢氯噻嗪。所有参与者还将参加结构化的有氧运动 干涉。主要目的是确定与氯沙坦和 HCTZ 相比，培哚普利是否可以改善自我 步态速度。第二个目的是确定培哚普利对 a) 运动能力的相对影响， b) 体重和成分，以及 c) 心血管风险循环指数。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数的影响 血管生成。这项研究预计将区分 FDA 批准的三种抗高血压药物的有益效果 针对临床相关人群中新出现的心血管危险因素的药物治疗。因此该研究有 对于迅速影响处方中的临床实践指南具有重要意义 为数百万美国人提供抗高血压药物。