Do Angiotensin-Converting Enzyme (ACE) Inhibitors Enhance the Effect of Exercise Rehabilitation in Patients With Hypertension and ACE DD and DI Genotypes?

Duzli Y, Grossman E, Gaides M, Segev S, Gal N, Ben-Dov I. Do angiotensin-converting enzyme (ACE) inhibitors enhance the effect of exercise rehabilitation in patients with hypertension and ACE DD and DI genotypes? Objective: To test whether pharmacologic angiotensin-converting enzyme (ACE) inhibition in carriers of the ACE DD or DI (D, deletion; I, insertion of 287 base pairs) genotypes can simulate the genetic advantage of the II genotype and thereby enhance the conditioning effects of aerobic exercise. Design: Nonrandomized controlled trial. Setting: Pulmonary institute. Participants: Twelve sedentary men with controlled hypertension (5 with DD genotype, 7 with DI genotype; age, 53±7y) treated by ACE inhibitors (study group) and 10 patients (8 men, 2 women; 2 with DD genotype, 8 with DI genotype; age, 54±10y) who were treated by other antihypertensive drugs (controls). Intervention: Exercise training. Main Outcome Measures: Training effect was measured by maximal oxygen uptake (V̇o₂max) anaerobic threshold (V̇o_2AT), and the corresponding work rates (WR) (in watts)-WRmax and WR_AT-before and after 10 weeks of training. Results: V̇o₂max increased by a mean of 10% (200mL/min) and WRmax by 14% (25W) in each group (P<.001). V̇o_2AT and WR_AT tended to increase more in the study group (V̇o_2AT: 10% [186±35mL/min] vs 5% [100±1mL/min]; P<.006; WR_AT: 19% [19±2W] vs 12% [11±3W]; P<.03; respectively). Conclusions: This study did not show an enhancement of exercise-related conditioning by pharmacologic ACE inhibition among hypertensive patients with ACE DD and DI genotypes, comparable to the advantage conferred by the II genotype.