The effect of perindopril on postural instability in older people with a history of falls-a randomised controlled trial

Deepa Sumukadas (Lead / Corresponding author), Rosemary Price, Marion E. T. McMurdo, Petra Rauchhaus, Allan Struthers, Stephen McSwiggan, Graham Arnold, Rami Abboud, Miles Witham

Research output: Contribution to journalArticle

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Abstract

Angiotensin converting enzyme inhibitors may improve exercise capacity and muscle function in older people but are often thought to increase falls risk. We investigated the effect of perindopril on postural stability in older people with a history of falls.Design: double-blind, parallel group, placebo-controlled randomised trial.Methods: we recruited people aged >65 years with at least one fall in the previous year. Participants received 4 mg perindopril or placebo daily for 15 weeks. The primary outcome was the between-group difference in force-plate measured anteroposterior (AP) sway at 15 weeks. Secondary outcomes included other measures of postural sway, limits of stability during maximal forward, right and left leaning, blood pressure, muscle strength, 6-min walk distance and falls. The primary outcome was assessed using two-way ANOVA, adjusted for baseline factors.Results: we randomised 80 participants. Mean age was 78.0 (SD 7.4) years; 60 (75%) were female. About 77/80 (96%) completed the trial. At 15 weeks there were no significant between-group differences in AP sway with eyes open (mean difference 0 mm, 95% CI -8 to 7 mm, P = 0.91) or eyes closed (mean difference 2 mm, 95% CI -7 to 12 mm, P = 0.59); no differences in other measures of postural stability, muscle strength or function. About 16/40 (42%) of patients in each group had orthostatic hypotension at follow-up. The median number (IQR) of falls was 1 (0,4) in the perindopril versus 1 (0,2) in the placebo group (P = 0.24).Conclusions: perindopril did not improve postural sway in older people at risk of falls.

Original languageEnglish
Pages (from-to)75-81
Number of pages7
JournalAge and Ageing
Volume47
Issue number1
Early online date11 Jul 2017
DOIs
Publication statusPublished - 1 Jan 2018

Fingerprint

Perindopril
Randomized Controlled Trials
Placebos
Muscle Strength
Orthostatic Hypotension
Angiotensin-Converting Enzyme Inhibitors
Analysis of Variance
Exercise
Blood Pressure
Muscles

Keywords

  • Journal article
  • Falls
  • Clinical trial
  • Angiotensin converting enzyme inhibitor
  • Postural sway
  • Older people
  • Falls
  • Angiotensin converting enzyme inhibitor
  • Older
  • Geriatric Assessment
  • Age Factors
  • Postural Balance/drug effects
  • Humans
  • Male
  • Scotland
  • Accidental Falls/prevention & control
  • Time Factors
  • Aged, 80 and over
  • Angiotensin-Converting Enzyme Inhibitors/adverse effects
  • Female
  • Sensation Disorders/complications
  • Double-Blind Method
  • Risk Factors
  • Treatment Outcome
  • Perindopril/adverse effects
  • Aged

Cite this

@article{9c72d0dca87c4d0f921a98fdfe0b3d5d,
title = "The effect of perindopril on postural instability in older people with a history of falls-a randomised controlled trial",
abstract = "Angiotensin converting enzyme inhibitors may improve exercise capacity and muscle function in older people but are often thought to increase falls risk. We investigated the effect of perindopril on postural stability in older people with a history of falls.Design: double-blind, parallel group, placebo-controlled randomised trial.Methods: we recruited people aged >65 years with at least one fall in the previous year. Participants received 4 mg perindopril or placebo daily for 15 weeks. The primary outcome was the between-group difference in force-plate measured anteroposterior (AP) sway at 15 weeks. Secondary outcomes included other measures of postural sway, limits of stability during maximal forward, right and left leaning, blood pressure, muscle strength, 6-min walk distance and falls. The primary outcome was assessed using two-way ANOVA, adjusted for baseline factors.Results: we randomised 80 participants. Mean age was 78.0 (SD 7.4) years; 60 (75{\%}) were female. About 77/80 (96{\%}) completed the trial. At 15 weeks there were no significant between-group differences in AP sway with eyes open (mean difference 0 mm, 95{\%} CI -8 to 7 mm, P = 0.91) or eyes closed (mean difference 2 mm, 95{\%} CI -7 to 12 mm, P = 0.59); no differences in other measures of postural stability, muscle strength or function. About 16/40 (42{\%}) of patients in each group had orthostatic hypotension at follow-up. The median number (IQR) of falls was 1 (0,4) in the perindopril versus 1 (0,2) in the placebo group (P = 0.24).Conclusions: perindopril did not improve postural sway in older people at risk of falls.",
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author = "Deepa Sumukadas and Rosemary Price and McMurdo, {Marion E. T.} and Petra Rauchhaus and Allan Struthers and Stephen McSwiggan and Graham Arnold and Rami Abboud and Miles Witham",
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pages = "75--81",
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The effect of perindopril on postural instability in older people with a history of falls-a randomised controlled trial. / Sumukadas, Deepa (Lead / Corresponding author); Price, Rosemary; McMurdo, Marion E. T.; Rauchhaus, Petra; Struthers, Allan; McSwiggan, Stephen; Arnold, Graham; Abboud, Rami; Witham, Miles.

In: Age and Ageing, Vol. 47, No. 1, 01.01.2018, p. 75-81.

Research output: Contribution to journalArticle

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T1 - The effect of perindopril on postural instability in older people with a history of falls-a randomised controlled trial

AU - Sumukadas, Deepa

AU - Price, Rosemary

AU - McMurdo, Marion E. T.

AU - Rauchhaus, Petra

AU - Struthers, Allan

AU - McSwiggan, Stephen

AU - Arnold, Graham

AU - Abboud, Rami

AU - Witham, Miles

N1 - The work was supported by funding from the Chief Scientist Office, Scottish Government Health Directorates (grant number CZH/4/856). The funders had no role in the design, execution, analysis and interpretation of data, or writing of the study report.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Angiotensin converting enzyme inhibitors may improve exercise capacity and muscle function in older people but are often thought to increase falls risk. We investigated the effect of perindopril on postural stability in older people with a history of falls.Design: double-blind, parallel group, placebo-controlled randomised trial.Methods: we recruited people aged >65 years with at least one fall in the previous year. Participants received 4 mg perindopril or placebo daily for 15 weeks. The primary outcome was the between-group difference in force-plate measured anteroposterior (AP) sway at 15 weeks. Secondary outcomes included other measures of postural sway, limits of stability during maximal forward, right and left leaning, blood pressure, muscle strength, 6-min walk distance and falls. The primary outcome was assessed using two-way ANOVA, adjusted for baseline factors.Results: we randomised 80 participants. Mean age was 78.0 (SD 7.4) years; 60 (75%) were female. About 77/80 (96%) completed the trial. At 15 weeks there were no significant between-group differences in AP sway with eyes open (mean difference 0 mm, 95% CI -8 to 7 mm, P = 0.91) or eyes closed (mean difference 2 mm, 95% CI -7 to 12 mm, P = 0.59); no differences in other measures of postural stability, muscle strength or function. About 16/40 (42%) of patients in each group had orthostatic hypotension at follow-up. The median number (IQR) of falls was 1 (0,4) in the perindopril versus 1 (0,2) in the placebo group (P = 0.24).Conclusions: perindopril did not improve postural sway in older people at risk of falls.

AB - Angiotensin converting enzyme inhibitors may improve exercise capacity and muscle function in older people but are often thought to increase falls risk. We investigated the effect of perindopril on postural stability in older people with a history of falls.Design: double-blind, parallel group, placebo-controlled randomised trial.Methods: we recruited people aged >65 years with at least one fall in the previous year. Participants received 4 mg perindopril or placebo daily for 15 weeks. The primary outcome was the between-group difference in force-plate measured anteroposterior (AP) sway at 15 weeks. Secondary outcomes included other measures of postural sway, limits of stability during maximal forward, right and left leaning, blood pressure, muscle strength, 6-min walk distance and falls. The primary outcome was assessed using two-way ANOVA, adjusted for baseline factors.Results: we randomised 80 participants. Mean age was 78.0 (SD 7.4) years; 60 (75%) were female. About 77/80 (96%) completed the trial. At 15 weeks there were no significant between-group differences in AP sway with eyes open (mean difference 0 mm, 95% CI -8 to 7 mm, P = 0.91) or eyes closed (mean difference 2 mm, 95% CI -7 to 12 mm, P = 0.59); no differences in other measures of postural stability, muscle strength or function. About 16/40 (42%) of patients in each group had orthostatic hypotension at follow-up. The median number (IQR) of falls was 1 (0,4) in the perindopril versus 1 (0,2) in the placebo group (P = 0.24).Conclusions: perindopril did not improve postural sway in older people at risk of falls.

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