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Perindopril shows no effect on postural balance of older adults at risk of falls

15 Aug 2017

The angiotensin converting enzyme (ACE) inhibitor perindopril does not appear to improve postural sway in older individuals at risk of falls, according to a study. Despite the lack of effect on postural balance, the drug does not worsen the rate of falls or orthostatic hypotension (OH).

A total of 80 individuals aged >65 years (mean 78 years; 75 percent female) with at least one fall event in the previous 12 months were randomized to receive 4 mg perindopril or placebo daily for 15 weeks. Force-plate measured anteroposterior (AP) sway at 15 weeks was the primary outcome. Measures of postural sway, limits of stability (during maximal forward, right and left leaning), blood pressure, muscle strength, 6-min walk distance and falls were also evaluated as secondary outcomes.

Of the participants, 77 (96 percent) completed the trial. There were no significant differences between the perindopril or placebo groups in terms of AP sway with eyes open (mean difference, 0 mm; 95 percent CI, −8 to 7; p=0.91) or eyes closed (mean difference, 2 mm; −7 to 12 mm; p=0.59). Likewise, no between-group differences were seen in other measures of postural stability, muscle strength or function.

At follow-up, OH was reported in about 42 percent of patients in each treatment group. The median number of falls was 1 (interquartile range, 0 to 4) in the perindopril group vs 1 (0 to 2) in the placebo group (p=0.24).

Findings of the current study “do not support a strategy of using ACE inhibitors to reduce falls in older people with a history of falls, but they equally suggest that [the drugs] may not have a deleterious effect on key risks for falls, including OH,” researchers said.

“There may therefore be little to gain by stopping ACE inhibitors in those who fall, particularly if other indications for [the drugs] (eg, heart failure, previous stroke or other vascular event) are present,” they added.

More research is needed to further clarify the effect of ACE inhibitors on falls risk in elderly individuals.

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