Perindopril and physiologic responses to exercise

Cardiovascular drugs have varying effects on hemodynamic, metabolic, and hormonal responses to exercise. To evaluate the effects of the novel angiotensin-converting enzyme (ACE) inhibitor, perindopril on these exercise-related responses, we studied 9 healthy volunteers in a double-blind, randomized, placebo-controlled trial. After a week of perindopril 4 mg orally daily or placebo therapy, volunteers performed a treadmill effort test; the sequence was repeated after a 1-week washout period. Perindopril caused a significant reduction in mean resting systolic and diastolic blood pressure (SBP, DBP) without increasing resting heart rate (HR); 15-min post-exercise SBP was also significantly reduced. There were no significant differences between the perindopril and placebo effort tests with respect to metabolic indexes studied (serum K+, plasma glucose, plasma free fatty acids) or plasma hormonal concentrations measured (ACTH and cortisol, norepinephrine (NE) and epinephrine (EPI), glucagon and insulin, growth hormone and prolactin, renin activity). In the perindopril arm of the study, however, there were modest but significant increases in mean serum K+ before exercise to immediately after exercise (0.4 +/- 0.1 mM, p < 0.01) and mean plasma glucose from before exercise to 5 min (0.6 +/- 0.2 mM, p < 0.01) and 15 min (0.5 +/- 0.2 mM, p < 0.05) after exercise. These data show that perindopril does not impair the hormonal changes associated with exercise in healthy subjects but induces a more consistent increase in blood K+ and glucose concentrations.