ACES - ACE inhibitors Combined with Exercise for hypertensive Seniors

该项目的目的是进行随机对照试验(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 在患有高血压的老年人中。功能状态，由身体性能的测量确定， 是预测老年人心血管结果的重要指标。功能受损的老年人 经历更多心血管事件，接受心脏手术的风险更高，患心血管疾病相关风险更高 死亡比功能更强的同龄人更多。患有高血压的老年人经历了功能加速下降， 目前，体育锻炼是防止这种下降的主要策略。然而，功能性的 对运动的反应是高度多变的，而且似乎受到降压药类型的影响 用药(S)控制血压。初步证据表明，与其他第一批相比- 系列降压药、血管紧张素转换酶(ACE)抑制剂增强运动衍生 改善老年高血压患者的功能状态。这项随机对照试验将检验这一假设。久坐不动 有功能障碍和高血压的老年人将从两个地点招募参加一项 随机临床试验，他们将被随机分配到三种一线抗高血压药物中的一种 药物：(1)血管紧张素转换酶抑制剂培哚普利，(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有组织的有氧运动干预。这场审判 将评估与氯沙坦和羟基喜树碱相比，培哚普利是否改善功能状态指数和 当与体育锻炼相结合时，有心血管风险。这项研究有望区分有益的 FDA批准的三种降压药物对老年高血压患者心血管危险因素的影响 与临床相关的人群。因此，这项研究对迅速影响临床具有重要意义。 为数百万美国人开出抗高血压药物的实践指南。

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.