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

Lorna Caulfield; Philip Heslop; Katherine E. Walesby; Deepa Sumukadas; Avan A. Sayer; Miles D. Witham

doi:10.1016/j.jamda.2020.07.012

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

Lorna Caulfield, Philip Heslop, Katherine E. Walesby, Deepa Sumukadas, Avan A. Sayer, Miles D. Witham (Lead / Corresponding author)

Research output: Contribution to journal › Review article › peer-review

8 Citations (Scopus)

136 Downloads (Pure)

Abstract

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; I ² = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I ² = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I ² = 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.

Original language	English
Pages (from-to)	1215-1221.E2
Number of pages	9
Journal	Journal of the American Medical Directors Association
Volume	22
Issue number	6
Early online date	26 Aug 2020
DOIs	https://doi.org/10.1016/j.jamda.2020.07.012
Publication status	Published - 1 Jun 2021

Keywords

Systematic review
angiotensin converting enzyme inhibitor
angiotensin receptor blocker
physical performance
sarcopenia

ASJC Scopus subject areas

General Nursing
Health Policy
Geriatrics and Gerontology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jamda.2020.07.012Licence: CC BY

Final Published VersionFinal published version, 834 KBLicence: CC BY

Cite this

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title = "Effect of Angiotensin System Inhibitors on Physical Performance in Older People - A Systematic Review and Meta-Analysis",

abstract = "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; I 2 = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I 2 = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I 2 = 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. ",

keywords = "Systematic review, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, physical performance, sarcopenia",

author = "Lorna Caulfield and Philip Heslop and Walesby, {Katherine E.} and Deepa Sumukadas and Sayer, {Avan A.} and Witham, {Miles D.}",

note = "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. Publisher Copyright: {\textcopyright} 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine",

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AU - Caulfield, Lorna

AU - Heslop, Philip

AU - Walesby, Katherine E.

AU - Sumukadas, Deepa

AU - Sayer, Avan A.

AU - Witham, Miles D.

N1 - 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. Publisher Copyright: © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine

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Y1 - 2021/6/1

N2 - 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; I 2 = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I 2 = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I 2 = 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.

AB - 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; I 2 = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I 2 = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I 2 = 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.

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KW - angiotensin converting enzyme inhibitor

KW - angiotensin receptor blocker

KW - physical performance

KW - sarcopenia

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DO - 10.1016/j.jamda.2020.07.012

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

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Leucine and ACE Inhibitors as Therapies for Sarcopenia; a Two by Two Factorial Randomised Placebo Controlled Trial (Joint with NHS Tayside, Imperial College London and University of Aberdeen)

Cite this

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Projects

Leucine and ACE Inhibitors as Therapies for Sarcopenia; a Two by Two Factorial Randomised Placebo Controlled Trial (Joint with NHS Tayside, Imperial College London and University of Aberdeen)

Cite this