What is the mechanism of action of this treatment?

Common treatments for high blood pressure work through several key mechanisms. ACE inhibitors and ARBs promote vasodilation by blocking the renin-angiotensin system, which helps relax blood vessels. Diuretics reduce blood volume by increasing urine output, thereby lowering blood pressure. Beta-blockers decrease heart rate and the force of contraction, reducing the heart's workload. Calcium channel blockers prevent calcium from entering heart and blood vessel cells, leading to vasodilation and decreased heart rate. These mechanisms are essential for high blood pressure patients as they target the underlying factors contributing to hypertension, thereby reducing the risk of cardiovascular events and improving overall cardiovascular health.

What side effects are associated with this type of intervention?

Common treatments for high blood pressure include ACE inhibitors, ARBs, calcium channel blockers, thiazide diuretics, and beta-blockers. ACE inhibitors and ARBs can cause side effects like cough, elevated blood potassium levels, and kidney dysfunction. Calcium channel blockers may lead to swelling in the lower extremities, dizziness, and constipation. Thiazide diuretics are associated with electrolyte imbalances, such as low potassium and sodium levels, and increased uric acid levels, which can lead to gout. Beta-blockers can cause fatigue, depression, and bradycardia (slow heart rate). Each medication class has its own profile of potential side effects, which should be considered when choosing the appropriate treatment.

What prior FDA approvals exist?

The FDA has approved several classes of antihypertensive medications for the treatment of high blood pressure. ACE inhibitors like enalapril, lisinopril, and benazepril work by blocking the production of angiotensin II, leading to vasodilation. Calcium channel blockers such as amlodipine and nifedipine prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. Thiazide diuretics, including hydrochlorothiazide, reduce blood volume by increasing urine output. Beta-blockers like esmolol and labetalol decrease heart rate and the force of contraction, thereby lowering blood pressure. These medications are often used in combination to achieve better blood pressure control.

What other types of research exist?

Promising novel alternatives to traditional antihypertensive medications for 2024 include: 1) New classes of drugs such as endothelin receptor antagonists and neprilysin inhibitors, which offer different mechanisms of action. 2) Combination therapies that integrate ACE inhibitors or ARBs with other agents like dihydropyridine calcium channel blockers for enhanced efficacy. 3) Innovative delivery methods such as sustained-release formulations to improve adherence and effectiveness. 4) Non-pharmacological interventions like structured exercise programs and dietary modifications, which have shown potential in reducing blood pressure when combined with medication.

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Angiotensin II Receptor Blocker

ACE Inhibitors + Exercise for High Blood Pressure (ACES Trial)

Phase 2

Waitlist Available

Led By Wendy Kohrt, PhD

Research Sponsored by University of Alabama at Birmingham

Eligibility Criteria Checklist

Specific guidelines that determine who can or cannot participate in a clinical trial

Must have

> 290 seconds needed to complete long-distance corridor walk test

Age 60 years and older

Must not have

Severe cardiac disease, including NYHA Class III or IV congestive heart failure, clinically significant aortic stenosis, history of cardiac arrest, use of a cardiac defibrillator, or uncontrolled angina

BP > 140/90, despite the use of three or more anti-hypertensive drugs

Timeline

Screening 3 weeks

Treatment Varies

Follow Up 32 weeks

Awards & highlights

Summary

This trial is testing three different blood pressure medications along with a regular exercise routine to see which combination works best for improving physical function in older adults with high blood pressure. The study focuses on people over 60 who have trouble moving around easily. It aims to find out if one medication helps them get more benefit from exercise by improving blood flow.

Who is the study for?

This trial is for seniors aged 60 and above with high blood pressure who lead a sedentary lifestyle, doing less than 150 minutes of moderate exercise per week. They must be willing to follow the study procedures and allow communication with their doctor. People with severe heart conditions, recent heart attacks, significant cognitive impairment, known allergies to ACE inhibitors, kidney or liver issues are not eligible.

What is being tested?

The ACES trial is testing whether different blood pressure medications (Losartan or Perindopril) combined with aerobic exercise affect seniors' physical function and cardiovascular risk factors differently compared to HCTZ medication alone. Participants will be randomly assigned to one of these treatment combinations in this controlled study.

What are the potential side effects?

Possible side effects from the medications include coughing, dizziness due to low blood pressure, high potassium levels which can affect heart rhythm, kidney problems, and allergic reactions. Exercise may cause muscle soreness or increase injury risk if not done properly.

Eligibility Criteria

Inclusion Criteria

You may be eligible if you check “Yes” for the criteria below

Select...

It takes me more than 290 seconds to complete a long walk test.

Select...

I am 60 years old or older.

Select...

I have high blood pressure, treated or untreated.

Exclusion Criteria

You may be eligible for the trial if you check “No” for criteria below:

Select...

I do not have severe heart problems like heart failure, aortic stenosis, or uncontrolled chest pain.

Select...

My blood pressure is over 140/90 even though I'm on three or more blood pressure medications.

Select...

I have chronic kidney disease.

Timeline

Screening ~ 3 weeks3 visits

Treatment ~ Varies

Follow Up ~ 32 weeks

Screening ~ 3 weeks

Treatment ~ Varies

Follow Up ~32 weeks

This trial's timeline: 3 weeks for screening, Varies for treatment, and 32 weeks for reporting.

Treatment Details

Study Objectives

Study objectives can provide a clearer picture of what you can expect from a treatment.

Primary study objectives

Gait speed

Secondary study objectives

Body composition

Circulating indices of cardiovascular risk

Six minute walk test

Trial Design

3Treatment groups

Active Control

Group I: PerindoprilActive Control2 Interventions

4 mg qd titrated to 8 mg qd perindopril + aerobic exercise

Group II: LosartanActive Control2 Interventions

50 mg qd titrated to 100 mg qd losartan + aerobic exercise

Group III: HCTZActive Control2 Interventions

12.5 mg qd titrated to 25 mg qd HCTZ + aerobic exercise

0 / 6Eligibility criteria met

Research Highlights

Information in this section is not a recommendation. We encourage patients to speak with their healthcare team when evaluating any treatment decision.

Mechanism Of Action

Side Effect Profile

Prior Approvals

Other Research

Common treatments for high blood pressure work through several key mechanisms. ACE inhibitors and ARBs promote vasodilation by blocking the renin-angiotensin system, which helps relax blood vessels. Diuretics reduce blood volume by increasing urine output, thereby lowering blood pressure. Beta-blockers decrease heart rate and the force of contraction, reducing the heart's workload. Calcium channel blockers prevent calcium from entering heart and blood vessel cells, leading to vasodilation and decreased heart rate. These mechanisms are essential for high blood pressure patients as they target the underlying factors contributing to hypertension, thereby reducing the risk of cardiovascular events and improving overall cardiovascular health.

New antihypertensive drugs under development.Towards triple vasopeptidase inhibitors for the treatment of cardiovascular diseases.Small artery remodelling in hypertension: causes, consequences and therapeutic implications.