Effect of Angiotensin System Inhibitors on Physical Performance in Older People – A Systematic Review and Meta-Analysis

Caulfield, Lorna, Heslop, Philip, Walesby, Katherine E., Sumukadas, Deepa, Sayer, Avan A. and Witham, Miles D. (2021) Effect of Angiotensin System Inhibitors on Physical Performance in Older People – A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 22 (6). 1215-1221.e2. ISSN 1525-8610

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Official URL: https://doi.org/10.1016/j.jamda.2020.07.012


Objective: 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. We aimed to summarize current evidence from randomised controlled trials in this area. Design: Systematic review and meta-analysis. 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. Methods: We 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. Results: Eight 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 Implications: Existing evidence does not support the use of ACE inhibitors or angiotensin receptor blockers as a single intervention to improve physical performance in older people.

Item Type: Article
Additional Information: Funding Information: This work was supported in part by project reference 13/53/03 funded by the Efficacy and Mechanism Evaluation Program, a Medical Research Council and National Institute for Health Research partnership.KEW is funded by a clinical research fellowship by both Alzheimer Scotland and The University of Edinburgh Center for Cognitive Aging and Cognitive Epidemiology, part of the cross council Lifelong Health and Well-Being Initiative (MR/L501530/1). Funding from the Biotechnology and Biological Sciences Research Council and Medical Research Council is gratefully acknowledged. The authors acknowledge support from the NIHR Newcastle Biomedical Research Center.
Uncontrolled Keywords: angiotensin converting enzyme inhibitor, angiotensin receptor blocker, physical performance, sarcopenia, Systematic review
Subjects: A900 Others in Medicine and Dentistry
B100 Anatomy, Physiology and Pathology
W200 Design studies
Department: Faculties > Arts, Design and Social Sciences > Design
Depositing User: Rachel Branson
Date Deposited: 04 Nov 2021 15:09
Last Modified: 05 Nov 2021 12:19
URI: http://nrl.northumbria.ac.uk/id/eprint/47638

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