Antihypertensive monotherapy or combined therapy: which is more effective on functional status?

ABSTRACT

Background: This study aims to analyze the effects of anti-hypertensive monotherapy and combined therapy on functional status, and cardiovascular risk outcomes in older adults.

Methods: This longitudinal non-randomized cohort study, involved hypertensive older adults (n = 440) aged 60 or more years with comorbidities. Participants underwent a community exercise training program and one of the following 2 conditions: i) use of daily mono-dose angiotensin-converting enzyme inhibitors (ACEi; n= 232); ii) combined therapy including ACEi plus other class agent (Combined; n= 208). Baseline and 2-year follow-up evaluations included the functional fitness, health-related quality of life (HRQoL), health history questionnaires, anthropometric and hemodynamic profile.

Results: Both experimental groups have significantly improved physical functional status, and have significantly decreased blood pressure and waist circumference. ACEi group has significantly reduced body mass and body mass index, the Combined group significantly reduced the waist-to-hip ratio. Additionally, both groups perceived better physical HRQoL.

Conclusions: Functional status has improved with ACEi medication and exercise training, regardless the ACEi medication therapy. Exercise training plus ACEi antihypertensive therapy should be recommended into the standard prescription practice to reduce the rate of physical disability among hypertensive older adults.

KEYWORDS:

• Functional status
• exercise
• angiotensin converting enzyme inhibitors
• Combined therapy
• cardiovascular risk factors
• physical health related quality of life

Acknowledgements

The authors are grateful to all medical interns of Santa Maria da Feira for their technical support, especially to Dr. Nunes Sousa and Macedo Coelho; to Santa Maria da Feira Council with a special greeting to Social Division, to Dr. Manuela Coelho and Francisco Rocha for the availability to the study prosecution in the community exercise program “Movimento e bem-estar”; to all Physical Education professionals in the exercise program, and finally, we also thank to all participants who gave literally their physical and mental contributions.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This work was supported by a doctoral grant from Portuguese Science and Technology Foundation (SFRH/BD/90221/2012).