Exercise performance during losartan‐ or atenolol‐based treatment in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy)

Abstract

The objective of the study was to assess the influence of left ventricular (LV) hypertrophy regression on exercise capacity in hypertensive patients. Doppler echocardiography was performed at rest and during exercise in 51 patients with electrocardiographic LV hypertrophy before and after 1 year of randomized blinded losartan- or atenolol-based antihypertensive treatment. After 1 year, blood pressure was comparably reduced by 32/14 and 27/13 mmHg, respectively, in the losartan and atenolol groups, but the atenolol group had higher mean LV mass index (118 vs 103 g/m2) and lower LV ejection fraction (61% vs 67%) and midwall shortening (15.8% vs 16.8%) (all p<0.05). Resting diastolic Doppler indices remained unchanged and did not differ between the groups. Peak oxygen uptake during exercise was virtually unchanged after 1 year and did not differ between the groups in spite of a lower peak exercise heart rate in atenolol-treated patients. In multivariate analysis, higher peak oxygen uptake at 1 year was associated with lower body mass index, and higher systolic blood pressure and shorter isovolumic relaxation time at peak exercise (multiple R2 = 0.51, p<0.01), while age, gender, heart rate increase during exercise, reduction in LV mass and study treatment did not enter. In conclusion, reduction in blood pressure and LV mass induced by losartan or atenolol treatment was not accompanied by improved exercise capacity after 1 year. The results may be explained by persistent impairment of myocardial relaxation influencing exercise capacity.

The renin–angiotensin system and prevention of age-related functional decline: where are we now?

“…However, similar interactions are not universal. For individuals with left ventricle hypertrophy (Gerdts et al 2006) or right ventricle dysfunction (Dore et al 2005), exercise capacity was not improved with ARB treatment. Moreover, disease states like insulin resistance may be more responsive to ACEi.…”

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

“…Table 1 shows details of the included studies. 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 Three trials included participants with functional impairment, 4 trials included older people with hypertension or elevated cardiovascular risk, and 1 trial included healthy older men. No trials specifically aimed to recruit participants with sarcopenia or frailty.…”

Effect of Antihypertensive and Statin Medication Use on Muscle Performance in Community-Dwelling Older Adults Performing Strength Training

“…Recent literature reviews showed that several drugs that target the renin-angiotensin system have shown beneficial effects on inflammation, skeletal muscle metabolism and oxygen delivery improvement [6,[23][24][25][26]. However, other studies presented contradicting findings [27][28][29][30][31][32][33][34][35][36]. This discrepancy could relate to the studies design (with or without exercise), the type of drug, the participants' characteristics and health status, the study duration, and the outcome measures.…”

“…The AHTD-users did not perform differently from non-users except that ARB-users showed significantly slightly more time to do the TUG test than did non-users. Other studies of ARB-users who had left ventricle hypertrophy or right ventricle dysfunction suggested no beneficial effects on exercise capacity [35,36]. Some indicated a protective association between ARB use and functional decline [39] while others showed its favourable interaction with exercise, reporting better functional exercise capacity [5].…”