title: Multi-modal intervention to reduce cardiovascular risk among hypertensive older adults: Design of a randomized clinical trial.
abstract: Persons aged over 65 years account for over 75% of healthcare expenditures and deaths attributable to cardiovascular disease (CVD). Accordingly, reducing CVD risk among older adults is an important public health priority. Functional status, determined by measures of physical performance, is an important predictor of cardiovascular outcomes in older adults and declines more rapidly in seniors with hypertension. To date, physical exercise is the primary strategy for attenuating declines in functional status. Yet despite the general benefits of training, exercise alone appears to be insufficient for preventing this decline. Thus, alternative or adjuvant strategies are needed to preserve functional status among seniors with hypertension. Prior data suggest that angiotensin converting enzyme inhibitors (ACEi) may be efficacious in enhancing exercise-derived improvements in functional status yet this hypothesis has not been tested in a randomized controlled trial. The objective of this randomized, double-masked pilot trial is to gather preliminary efficacy and safety data necessary for conducting a full-scale trial to test this hypothesis. Sedentary men and women ≥ 65 years of age with functional limitations and hypertension are being recruited into this 24 week intervention study. Participants are randomly assigned to one of three conditions: (1) ACEi plus exercise training, (2) thiazide diuretic plus exercise training, or (3) AT1 receptor antagonist plus exercise training. The primary outcome is change in walking speed and secondary outcomes consist of other indices of CV risk including exercise capacity, body composition, as well as circulating indices of metabolism, inflammation and oxidative stress.
authors.affiliation: Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States; Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, United States. Electronic address: tbuford@ufl.edu.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Buford
authors.affiliation: Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Anton
authors.affiliation: Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States; North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
authors.affiliation: Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States.
authors.forename: Christy S
authors.initials: CS
authors.lastname: Carter
authors.affiliation: Department of Statistics & Data Sciences and Department of Integrative Biology, College of Natural Sciences, University of Texas, Austin, TX, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Daniels
authors.affiliation: Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States.
authors.forename: Marco
authors.initials: M
authors.lastname: Pahor
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001786:Blood Glucose; D001794:Blood Pressure; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000517:prevention & control; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D010809:Physical Fitness; D012307:Risk Factors; D057185:Sedentary Behavior; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D016138:Walking
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001786:Blood Glucose; D008055:Lipids; D049993:Sodium Chloride Symporter Inhibitors
keywords: ACE; Aging; Antihypertensive; Exercise; Hypertension; Physical activity