Onder Graziano, Vedova Cecilia Della, Pahor Marco
Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome - Italy.
Curr Pharm Des. 2006;12(16):2057-64. doi: 10.2174/138161206777442137.
Angiotensin-converting enzyme (ACE) inhibitors reduce morbidity, mortality, hospital admissions, and decline in physical function and exercise capacity in congestive heart failure (CHF) patients. These therapeutic effects are attributed primarily to beneficial cardiovascular actions of these drugs. However, it has been suggested that ACE inhibitor-induced positive effects may also be mediated by direct action on the skeletal muscle. In particular, two recently published observational studies documented that among hypertensive subjects free of CHF, treatment with ACE inhibitors was associated with better performance and muscular outcomes and genetic studies also support the hypothesis that the ACE system may be involved in physical performance and skeletal muscle function. Effects on the skeletal muscle are probably mediated by mechanical, metabolic, anti-inflammatory, nutritional, neurological and angiogenetic actions of these drugs. These studies may have major public health implications for older adults, as consequence of the fact that, in this population, gradual loss of muscle mass and muscle strength can play a key role in the onset and progression of disability. Therefore, if findings of observational studies will be later confirmed in randomized controlled trials, ACE inhibitors could represent an effective intervention to prevent physical decline in the elderly, leading to greater autonomy in this growing population.
血管紧张素转换酶（ACE）抑制剂可降低充血性心力衰竭（CHF）患者的发病率、死亡率、住院率，并减缓其身体功能和运动能力的衰退。这些治疗效果主要归因于这些药物有益的心血管作用。然而，有人提出，ACE抑制剂产生的积极效果也可能是通过对骨骼肌的直接作用介导的。特别是，最近发表的两项观察性研究表明，在没有CHF的高血压受试者中，使用ACE抑制剂治疗与更好的身体表现和肌肉结局相关，并且基因研究也支持ACE系统可能参与身体表现和骨骼肌功能的假说。这些药物对骨骼肌的影响可能是通过其机械、代谢、抗炎、营养、神经和血管生成作用介导的。这些研究可能对老年人具有重大的公共卫生意义，因为在这一人群中，肌肉质量和肌肉力量的逐渐丧失可能在残疾的发生和发展中起关键作用。因此，如果观察性研究的结果随后在随机对照试验中得到证实，ACE抑制剂可能代表一种有效的干预措施，以防止老年人身体机能下降，从而使这一不断增长的人群获得更大的自主性。
