Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Cardiovascular Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
Arch Med Res. 2023 Nov;54(7):102890. doi: 10.1016/j.arcmed.2023.102890. Epub 2023 Sep 21.
Age-related muscle decline, called sarcopenia, and hypertension are commonly observed in patients with chronic obstructive pulmonary disease (COPD). Angiotensin receptor blockers (ARBs) are common antihypertensive medications with muscle protective effects. However, the anti-sarcopenic potential and associated mechanisms of ARBs in hypertensive patients with COPD are unknown.
We aimed to investigate the potential contribution of neuromuscular junction (NMJ) stability as a driving mechanism of ARBs-induced muscle protection.
We categorized 236 patients with COPD into normotensive (n = 79) and hypertensive, based on treatment with ARB (n = 82), and other antihypertensive drugs (n = 75). Hypertensive patients with COPD were evaluated at two time points one year apart. Handgrip strength (HGS), body composition, short physical performance battery (SPPB), and plasma c-terminal agrin fragment-22 (CAF22) as a marker of NMJ degradation were measured.
Patients with COPD exhibited reduced HGS and SPPB scores, and higher levels of CAF22 than controls, regardless of hypertension status. ARBs treatment improved HGS and gait speed and reduced plasma CAF22 levels in hypertensive patients with COPD (all p <0.05). ARBs also prevented the decline in SPPB components, including maintaining balance, gait speed, and the ability to rise from a chair in hypertensive patients with COPD (all p <0.05). We also found dynamic associations of plasma CAF22 with HGS, gait speed, and SPPB scores in hypertensive patients with COPD.
Altogether, ARB treatment preserves skeletal muscle health and functional capacity in hypertensive patients with COPD by reducing plasma CAF22 and possibly repairing NMJs.
与年龄相关的肌肉衰退，即肌肉减少症，以及高血压在慢性阻塞性肺疾病（COPD）患者中很常见。血管紧张素受体阻滞剂（ARBs）是常用的具有肌肉保护作用的降压药物。然而，ARBs 对 COPD 合并高血压患者的抗肌肉减少作用及其相关机制尚不清楚。
我们旨在研究神经肌肉接头（NMJ）稳定性作为 ARBs 诱导肌肉保护的驱动机制的潜在贡献。
我们根据 ARB（n=82）和其他降压药物（n=75）的治疗情况，将 236 例 COPD 患者分为血压正常组（n=79）和高血压组。高血压 COPD 患者在一年的两个时间点进行评估。测量握力（HGS）、身体成分、短体性能电池（SPPB）和血浆 C 末端 Agrin 片段-22（CAF22），作为 NMJ 降解的标志物。
无论高血压状态如何，COPD 患者的 HGS 和 SPPB 评分均降低，CAF22 水平升高。ARB 治疗改善了高血压 COPD 患者的 HGS 和步态速度，并降低了血浆 CAF22 水平（均 p<0.05）。ARB 还可防止 SPPB 成分的下降，包括维持高血压 COPD 患者的平衡、步态速度和从椅子上站起来的能力（均 p<0.05）。我们还发现高血压 COPD 患者血浆 CAF22 与 HGS、步态速度和 SPPB 评分之间存在动态关联。
总之，ARB 治疗通过降低血浆 CAF22 和可能修复 NMJ，可维持高血压 COPD 患者的骨骼肌健康和功能能力。
