Study Examines Effects of ACE-I and ARB on Outcomes in COPD Patients

Treatment with ACE-I/angiotensin receptor blocker or ACE (I/D) polymorphism do not appear to influence response to pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD), according to a recent study.

Previous research has suggested a relationship between ACE genotype and physical performance, and ACE-I use in patients with hypertension has been associated with quadriceps strength and walking speed. These data lead researchers to hypothesize that ACE (I/D) polymorphism and treatment with angiotensin II receptor blockers (ARB) could influence response to PR—a program to strengthen muscles and increase endurance—in patients with COPD.
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The researchers conducted 2 studies to test their hypothesis. In the first, researchers compared responses to PR among 168 COPD patients between different ACE insertion/deletion polymorphism genotypes. In the second study, baseline characteristics and response to PR were compared in 373 patients with COPD taking and not taking ACE inhibitors or ARBs.

Overall, incremental shuttle walk distance improved similarly in all 3 genotypes (DD/ID/II) in patients in the first study. In the second study, fat free mass index was higher in patients taking ACE-I/ARB than those that were not (17.8 kg m^-2 vs 16.5 kg/m²), but change in fat free mass, walking distance, and quality of life did not differ between the groups.

“The present data suggest that the beneficial response to PR in COPD patients was not strongly influenced by their ACE (I/D) genotype, or by pharmacological [renin–angiotensin system] antagonism. However, long-term use of an ACE-I/ARB was associated with relatively preserved [fat free mass] in patients referred for PR,” the researchers concluded.

“Although trial data do not support a beneficial effect from the addition of an ACE-I in COPD patients who do not have a conventional clinical indication, the present data do not suggest that there is any advantage to avoiding or stopping ACE-I in COPD patients in whom they are indicated.”

—Michael Potts

Reference:

Kon SSC, Jolley CJ, Shrikrishna D, et al. ACE and response to pulmonary rehabilitation in COPD: two observational studies [published online March 8, 2017]. BMJ Open Resp Res. doi: 10.1136/bmjresp-2016-000165.