The effect of perindopril on postural instability in older people with a history of falls—a randomised controlled trial

Abstract Angiotensin converting enzyme inhibitors may improve exercise capacity and muscle function in older people but are often thought to increase falls risk. We investigated the effect of perindopril on postural stability in older people with a history of falls. Design double-blind, parallel gro...

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Bibliographic Details
Published in:Age and ageing 2018-01, Vol.47 (1), p.75-81
Main Authors: Sumukadas, Deepa, Price, Rosemary, McMurdo, Marion E T, Rauchhaus, Petra, Struthers, Allan, McSwiggan, Stephen, Arnold, Graham, Abboud, Rami, Witham, Miles
Format: Article
Language:English
Subjects:
Accidental Falls - prevention & control
Age Factors
Aged
Aged, 80 and over
Angiotensin
Angiotensin converting enzyme inhibitors
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Blood pressure
Clinical research
Clinical trials
Double-Blind Method
Falls
Female
Geriatric Assessment
Humans
Hypotension
Male
Muscle strength
Older people
Peptidyl-dipeptidase A
Perindopril - adverse effects
Perindopril - therapeutic use
Postural Balance - drug effects
Posture
Research Paper
Risk Factors
Scotland
Sensation Disorders - complications
Sensation Disorders - diagnosis
Sensation Disorders - drug therapy
Sensation Disorders - physiopathology
Time Factors
Treatment Outcome
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Summary:Abstract Angiotensin converting enzyme inhibitors may improve exercise capacity and muscle function in older people but are often thought to increase falls risk. We investigated the effect of perindopril on postural stability in older people with a history of falls. Design double-blind, parallel group, placebo-controlled randomised trial. Methods we recruited people aged >65 years with at least one fall in the previous year. Participants received 4 mg perindopril or placebo daily for 15 weeks. The primary outcome was the between-group difference in force-plate measured anteroposterior (AP) sway at 15 weeks. Secondary outcomes included other measures of postural sway, limits of stability during maximal forward, right and left leaning, blood pressure, muscle strength, 6-min walk distance and falls. The primary outcome was assessed using two-way ANOVA, adjusted for baseline factors. Results we randomised 80 participants. Mean age was 78.0 (SD 7.4) years; 60 (75%) were female. About 77/80 (96%) completed the trial. At 15 weeks there were no significant between-group differences in AP sway with eyes open (mean difference 0 mm, 95% CI −8 to 7 mm, P = 0.91) or eyes closed (mean difference 2 mm, 95% CI −7 to 12 mm, P = 0.59); no differences in other measures of postural stability, muscle strength or function. About 16/40 (42%) of patients in each group had orthostatic hypotension at follow-up. The median number (IQR) of falls was 1 (0,4) in the perindopril versus 1 (0,2) in the placebo group (P = 0.24). Conclusions perindopril did not improve postural sway in older people at risk of falls. Clinical Trials Registration ISRCTN58995463
ISSN:0002-0729
1468-2834
DOI:10.1093/ageing/afx127