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J Gerontol A Biol Sci Med Sci. 2019 May 9. pii: glz120. doi: 10.1093/gerona/glz120. [Epub ahead of print]

Comparative effects of ACE inhibitors and ARBs on response to a physical activity intervention in older adults: results from Lifestyle Interventions for Elders (LIFE) study.

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Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL.
Center for Drug Evaluation & Safety, University of Florida, Gainesville, FL.
Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL.
Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Arnold School of Public Health, University of South Carolina, Columbia, SC.
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA.
Department of Medicine, University of Alabama-Birmingham, Birmingham, AL.
Institute on Aging, Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL.



Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may protect against aging-related decline. This study directly compared ACEis and ARBs on associations with risk of mobility disability in older adults when combined with a physical activity intervention.


This was a secondary analysis of the Lifestyle Interventions for Elders (LIFE) trial. Participants age 70-89 years were randomized to a physical activity (PA) or health education (HE) intervention. Outcomes included incident and persistent major mobility disability (MMD), injurious falls, Short Physical Performance Battery (SPPB), and gait speed. For this analysis, only participants who reported ACEi or ARB use at baseline were included. Baseline differences between ACEi/ARB groups were adjusted for using inverse probability of treatment weights (IPTW). Weighted Cox proportional hazard models and analysis of covariance (ANCOVA) models were used to evaluate the independent effects of medications and interaction effects with the intervention on each outcome.


Of 1,635 participants in the LIFE study, 796 used either an ACEi (496, 62.3%) or ARB (300, 37.7%). Compared to ACEi users, ARB users had 28% lower risk (HR=0.72 [0.60-0.85]) of incident MMD and 35% (HR=0.65 [0.52-0.82]) lower risk of persistent MMD while no interaction between medication use and intervention was observed. Risk of injurious falls and changes in SPPB or gait speed were not different between ARB and ACEi users.


These results suggest that ARBs may protect from MMD by other mechanisms than improving physical performance.


angiotensin converting enzyme inhibitors; angiotensin receptor blockers; falls; mobility; renin-angiotensin system


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