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: 10670590
• 负责人: Thomas W Buford
• 金额: $ 51.55万
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10670590
• 关键词: Adjuvant; Aerobic Exercise; American; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Attenuated; 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 Clinical Trials; 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; angiogenesis; antagonist; base; blood pressure control; 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; hypertensive; improved; indexing; member; 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

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 older adults with functional limitations and hypertension will be recruited from two sites to participate in a randomized clinical trial in which they 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. This trial will evaluate whether, compared to losartan and HCTZ, perindopril improves indices of functional status and cardiovascular risk when combined with physical exercise. 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.

本项目的目的是进行一项随机对照试验（RCT），以确定是否选择 抗高血压药物影响功能状态和其他心血管危险因素的变化 老年高血压患者中。功能状态，通过身体表现的测量来确定， 是老年人心血管结局的重要预测因素。功能受损的老年人 发生更多CV事件，接受心脏手术的风险较高，CVD相关风险较高 死亡率高于功能更高的同龄人。患有高血压的老年人会经历加速的功能衰退， 目前，体育锻炼是防止这种下降的主要策略。然而，功能 对运动的反应是高度可变的，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，与其他第一次- 线抗高血压药，血管紧张素转换酶（ACE）抑制剂增强运动源性 改善老年高血压患者的功能状态。本RCT将检验这一假设。久坐 将从两个地点招募有功能限制和高血压的老年人参加一项 一项随机临床试验，患者将被随机分配至三种一线抗高血压药物之一 药物：（1）ACE抑制剂培哚普利，（2）AT 1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有组织的有氧运动干预。本试验 将评估与氯沙坦和HCTZ相比，培哚普利是否改善了功能状态指数， 心血管风险与体育锻炼相结合。这项研究有望区分有益的 三种FDA批准的抗高血压药物对一种新出现的心血管危险因素的影响， 临床相关人群。因此，该研究对迅速影响临床 为数百万美国人开具抗高血压药物处方的实践指南。