Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure

Gambassi, Giovanni; Lapane, Kate L.; Sgadari, Antonio; Carbonin, Pierugo; Gatsonis, Constantine; Lipsitz, Lewis A.; Mor, Vincent; Bernabei, Roberto

doi:10.1001/archinte.160.1.53

Cited by 92 publications

(51 citation statements)

References 69 publications

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“…Hypertensive subjects on ACE inhibitors had faster gait velocity than those not on ACE inhibitors in our study, supporting previous reports, 19,20 In the Women's Health and Aging study, 19 ACE inhibitor use in hypertensive older women was associated with reduced decline in walking speed. The SAGE study 20 reported an association between ACE inhibitors and reduced functional decline in older adults with congestive heart failure.…”

Section: Discussionsupporting

confidence: 91%

“…Possible explanations for the effect of ACE inhibitors on gait include direct effects on muscle membrane, modulating proinflammatory responses triggered by angiotensin, and improved cardiac function. 19,20 The strengths of this study include the systematic gait evaluations using validated techniques and a nondisabled community-residing sample. There is a paucity of quantitative gait studies in this age group.…”

Section: Discussionmentioning

confidence: 99%

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Gait Characteristics in Nondisabled Community-Residing Nonagenarians

Krishnamurthy

2006

Archives of Physical Medicine and Rehabilitation

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Objective-To determine gait performance in community-residing nonagenarians.Design-Nested case-control study. Setting-Community.Participants-Thirty-one nondisabled nonagenarians (17 women) and 170 young-old controls (age range, 70-85y) participating in a longitudinal study. Interventions-Not applicable.Main Outcome Measures-Systematic clinical and quantitative gait assessments. We also examined the association of gait velocity with death over a 1-year period.Results-Nonagenarian men had better performance on all quantitative gait parameters examined compared with women. Male sex (β=.58; 95% confidence interval [CI], 9.95-38.89) and depressive symptoms (β=-.34; 95% CI, -6.73 to -0.04) were independently associated with gait velocity in multivariate linear regression models. The 6 hypertensive nonagenarians on angiotensin-converting enzyme (ACE) inhibitors had faster gait velocity (median, 103.1cm/s) compared with the 8 hypertensive nonagenarians not on ACE inhibitors (median, 77.5cm/s; P=.029). Nonagenarians had worse quantitative gait parameters compared with the young-old controls, though the differences were less marked when subjects with clinically normal gaits in both groups were compared. Gait velocity did not predict survival over 1-year follow-up.Conclusions-Gait characteristics in nondisabled community-residing nonagenarians are associated with male sex, depressive symptoms, and medications. The quantitative gait measures in this sample of nondisabled nonagenarians provide a yardstick to compare younger age groups. KeywordsGait; Nonagenarians; Rehabilitation The prevalence of nonagenarians (age range, 90-99y) in the population increased 8-fold between 1950 and 1990, and represents the fastest growing age segment behind centenarians who increased 20-fold during the same time span. 1,2 There is growing interest in defining Reprints to Joe Verghese, MD, Einstein Aging Study,

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Gait Characteristics in Nondisabled Community-Residing Nonagenarians

Krishnamurthy

2006

Archives of Physical Medicine and Rehabilitation

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“…Observational data suggest that ACE inhibitor use in elderly heart failure patients may preserve cognition, slow functional decline, and reduce hospitalizations and perhaps even mortality, even in patients with relative contraindications, such as mild to moderate renal impairment (137)(138)(139). The beta-blocker nebivolol has been studied in 2128 patients 70 years of age or older with clinical evidence of heart failure regardless of ejection fraction (140).…”

Section: Recommendationsmentioning

confidence: 99%

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

Arnold¹,

Liu²,

Demers³

et al. 2006

Canadian Journal of Cardiology

363

256

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“…One may be inclined to postulate the former, because many antihypertensive medications have been associated with preclinical functional disability as adverse effects. 4,8 The benefits of treatment may outweigh its adverse effects.…”

mentioning

confidence: 99%

“…4,8 For example, in persons with heart failure, angiotensin-converting enzyme inhibitors have been shown to be associated with a decreased rate of decline in physical function for persons with heart failure. 8 After this study, Onder et al 9 investigated the association between angiotensin-converting enzyme inhibitors and physical performance and muscle strength in women free of heart failure and compared 4 groups: patients on angiotensin-converting enzyme inhibitors, patients treated with other antihypertensive medications continuously, patients treated with other antihypertensive medications irregularly, and patients with normal BP. Over 3 years, decline in muscle and knee extensor strength was statistically significantly lower in patients who had been treated with angiotensin-converting enzyme inhibitors as compared with the other cohorts.…”

mentioning

confidence: 99%

Blood Pressure and Disability

Elias

2007

Hypertension

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D isability has been defined as an inability to perform an action in a way that is consistent with the purpose of an organ or an organ system. 1 Preclinical disability, often detected by self-report instruments, is the term for functional limitations that are not clinically diagnosed but nonetheless represent a transition between impairment and disability. 1 Disability is a major public health problem, 1,2 yet there is little information currently available with respect to the role of blood pressure (BP) in its development.It is clear that hypertension-associated diseases and events, eg, stroke, myocardial infarction, angina pectoris, heart failure, and peripheral vascular disease, are risk factors for disability. 1,3,4 Considerably less attention has been focused on the more direct associations between hypertension and disability. In 1985, hypertension was related to disability in the Framingham Heart Study. 3 Nine years later, Hubert and Fries 5 reported an association between the diagnosis of hypertension and disability in a university runners club.Thirteen years later, in this issue of Hypertension, Hajjar et al 2 report a statistically significant association between hypertension and disability and concurrent and prospective associations between systolic BP and disability among 999 stroke-free men and women participating in the Charleston Heart Study, 39% of whom were African American. Concurrently and prospectively measured systolic BP values were positively related to increasing disability as assessed by 3 functional measures: (1) Nagi's Congruency in Medical and Self-Assessment of Disability Scale; (2) the Rosow-Breslaw Scale; and (3) the Katz Activities of Daily Living Scale. Thus, demonstration of a "dose-response" relationship between BP and multiple functional disability measures may be expected to stimulate a timely succession of studies, especially because many unanswered and important questions are raised about possible mechanisms. Hajjar et al 2 suggest the following candidate mechanisms for the positive association between systolic BP and increments in disability over time: white matter hyperintensities in the brain, cerebrovascular function, overall lean muscle mass, inflammation or changes in the renin angiotensin system, and cognitive function. The complexity of understanding these mechanisms may be illustrated by considering cognition as just 1 example of a variable intervening between BP and disability.With respect to cognition, the emphasis on executive functioning (planning, organizing, and properly sequencing activities) and fluid intellect (problem solving) is well placed, because adequate performance in these domains is necessary to meet the heavy demands of managing one's work and personal affairs, as well as everyday life demands, such as shopping, cooking, house management, and dressing. Thus, although each of the proposed mechanisms deserves comment, we will focus on cognitive functioning for 2 reasons: we can illustrate the complexity involved in identifying mechanisms intervening...

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Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure

Cited by 92 publications

References 69 publications

Gait Characteristics in Nondisabled Community-Residing Nonagenarians

Gait Characteristics in Nondisabled Community-Residing Nonagenarians

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

Blood Pressure and Disability

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