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Angiotensin-converting enzyme inhibition as an adjunct to pulmonary rehabilitation in COPD

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Title: Angiotensin-converting enzyme inhibition as an adjunct to pulmonary rehabilitation in COPD
Authors: Curtis, KJ
Meyrick, VM
Mehta, B
Haji, GS
Li, K
Montgomery, H
Man, WD-C
Polkey, MI
Hopkinson, NS
Item Type: Journal Article
Abstract: Rationale: Epidemiological studies in older individuals have found an association between use of ACE-inhibition (ACE-I) therapy and preserved locomotor muscle mass, strength and walking speed. ACE-I therapy might therefore have a role in the context of pulmonary rehabilitation. Objectives: We investigated the hypothesis that enalapril, an ACE-inhibitor, would augment the improvement in exercise capacity seen during pulmonary rehabilitation. Methods: We performed a double-blind, placebo-controlled, parallel-group randomised controlled trial. COPD patients, with at least moderate airflow obstruction and taking part in pulmonary rehabilitation, were randomised to either 10 weeks therapy with an ACE-inhibitor (10mg enalapril) or placebo. Measurements: The primary outcome measurement was the change in peak power (assessed using cycle ergometry) from baseline. Main Results: Eighty patients were enrolled, seventy-eight randomised (age 67±8years, FEV1 48±21% predicted), and sixty-five completed the trial (34 placebo, 31 ACE-inhibitor). The ACE-inhibitor treated group demonstrated a significant reduction in systolic blood pressure (Δ-16mmHg, 95% CI -22 to -11) and serum ACE activity (Δ-18IU/L, 95% CI -23 to -12) versus placebo (between group differences p<0.0001). Peak power increased significantly more in the placebo group (placebo Δ+9 Watts, 95% CI 5 to 13 vs. ACE-I Δ+1 Watt, 95% CI -2 to 4, between group difference 8 Watts, 95% CI 3 to 13, p=0.001). There was no significant between group difference in quadriceps strength or health-related quality of life. Conclusion: Use of the ACE-inhibitor enalapril alongside a programme of pulmonary rehabilitation, in patients without an established indication for ACE-inhibition, reduced the peak work rate response to exercise training in COPD patients. Clinical trial registration available at www.controlled-trials.com, ID ISRCTN79038750.
Issue Date: 1-Dec-2016
Date of Acceptance: 1-Jun-2016
URI: http://hdl.handle.net/10044/1/33331
DOI: 10.1164/rccm.201601-0094OC
ISSN: 1535-4970
Publisher: American Thoracic Society
Start Page: 1349
End Page: 1357
Journal / Book Title: American Journal of Respiratory and Critical Care Medicine
Volume: 194
Issue: 11
Copyright Statement: Copyright © 2016 by the American Thoracic Society
Sponsor/Funder: Medical Research Council (MRC)
National Institute for Health Research
Medical Research Council (MRC)
Funder's Grant Number: MR/J000620/1
CTF-01-12-04
G0701628
Keywords: Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
Respiratory System
General & Internal Medicine
COPD
renin-angiotensin system
exercise
rehabilitation
SKELETAL-MUSCLE
QUADRICEPS STRENGTH
EXERCISE CAPACITY
GENE POLYMORPHISM
PHYSICAL FUNCTION
CAPTOPRIL
PERFORMANCE
TRIAL
MASS
COPD
exercise
rehabilitation
renin–angiotensin system
Aged
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Combined Modality Therapy
Double-Blind Method
Enalapril
Exercise Tolerance
Female
Humans
Male
Pulmonary Disease, Chronic Obstructive
Quality of Life
Treatment Outcome
Humans
Pulmonary Disease, Chronic Obstructive
Enalapril
Angiotensin-Converting Enzyme Inhibitors
Treatment Outcome
Combined Modality Therapy
Double-Blind Method
Blood Pressure
Exercise Tolerance
Quality of Life
Aged
Female
Male
11 Medical and Health Sciences
Respiratory System
Publication Status: Published
Online Publication Date: 2016-06-02
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine