open access

Vol 23, No 4 (2019)
ORIGINAL PAPERS
Published online: 2019-12-16
Get Citation

Effect of short-term physical exercise on serum markers of skeletal muscle damage in hypertensive patients treated with a combination of statin and angiotensin-converting enzyme inhibitor

Pawel Deska, Michał Nowicki
DOI: 10.5603/AH.a2019.0018
·
Arterial Hypertension 2019;23(4):256-262.

open access

Vol 23, No 4 (2019)
ORIGINAL PAPERS
Published online: 2019-12-16

Abstract

Background. Muscle strain during physical exercise may lead to muscle damage and hyperkalaemia. Commonly prescribed drugs including statins and angiotensin-converting enzyme inhibitors (ACEI) may increase serum potassium and cause muscle damage. We postulated that the risk may be even higher if the patients are treated with a combination of statin and ACEI. The aim of the study was to compare the effect of moderate intensity short-term physical exercise on the changes of muscle injury markers serum carbonic anhydrase 3 and creatine kinase in patients with arterial hypertension receiving ACEI and statin.

Material and methods. Eighteen patients with arterial hypertension treated with ACEI were included in a prospective
placebo-controlled cross-over study. 18 healthy individuals served as controls. Hypertensive patients underwent 30-minute exercise test, which was repeated two times in a random order after the administration of ACEI with statin or ACEI with placebo. Each treatment period lasted 8 weeks separated by 2-week wash-out. Normotensive subjects underwent a single exercise test. Serum carbonic anhydrase 3 (CAIII) and creatine kinase (CK) activity were measured before and after exercise and recovery.

Results. At baseline and during the exercise CAIII was significantly higher in healthy volunteers compared to hypertensive patients. CAIII increased significantly during exercise only after treatment with both ACEI and statin. Serum CK was higher in hypertensive patients treated with ACEI plus statin during all exercise tests.

Conclusions. Addition of statin to ACEI in patients with arterial hypertension does not increase the risk of muscle damage during moderate intensity short-term physical exercise.

Abstract

Background. Muscle strain during physical exercise may lead to muscle damage and hyperkalaemia. Commonly prescribed drugs including statins and angiotensin-converting enzyme inhibitors (ACEI) may increase serum potassium and cause muscle damage. We postulated that the risk may be even higher if the patients are treated with a combination of statin and ACEI. The aim of the study was to compare the effect of moderate intensity short-term physical exercise on the changes of muscle injury markers serum carbonic anhydrase 3 and creatine kinase in patients with arterial hypertension receiving ACEI and statin.

Material and methods. Eighteen patients with arterial hypertension treated with ACEI were included in a prospective
placebo-controlled cross-over study. 18 healthy individuals served as controls. Hypertensive patients underwent 30-minute exercise test, which was repeated two times in a random order after the administration of ACEI with statin or ACEI with placebo. Each treatment period lasted 8 weeks separated by 2-week wash-out. Normotensive subjects underwent a single exercise test. Serum carbonic anhydrase 3 (CAIII) and creatine kinase (CK) activity were measured before and after exercise and recovery.

Results. At baseline and during the exercise CAIII was significantly higher in healthy volunteers compared to hypertensive patients. CAIII increased significantly during exercise only after treatment with both ACEI and statin. Serum CK was higher in hypertensive patients treated with ACEI plus statin during all exercise tests.

Conclusions. Addition of statin to ACEI in patients with arterial hypertension does not increase the risk of muscle damage during moderate intensity short-term physical exercise.

Get Citation

Keywords

physical exercise; arterial hypertension; carbonic anhydrase III; creatine kinase; angiotensin-converting enzyme inhibitor; HMG-CoA reductase inhibitor

About this article
Title

Effect of short-term physical exercise on serum markers of skeletal muscle damage in hypertensive patients treated with a combination of statin and angiotensin-converting enzyme inhibitor

Journal

Arterial Hypertension

Issue

Vol 23, No 4 (2019)

Pages

256-262

Published online

2019-12-16

DOI

10.5603/AH.a2019.0018

Bibliographic record

Arterial Hypertension 2019;23(4):256-262.

Keywords

physical exercise
arterial hypertension
carbonic anhydrase III
creatine kinase
angiotensin-converting enzyme inhibitor
HMG-CoA reductase inhibitor

Authors

Pawel Deska
Michał Nowicki

References (35)
  1. Nikolaidis M, Jamurtas A, Paschalis V, et al. The Effect of Muscle-Damaging Exercise on Blood and Skeletal Muscle Oxidative Stress. Sports Med. 2008; 38(7): 579–606.
  2. Siracusa J, Koulmann N, Sourdrille A, et al. Phenotype-Specific Response of Circulating miRNAs Provides New Biomarkers of Slow or Fast Muscle Damage. Front Physiol. 2018; 9: 684.
  3. Tomaszewski M, Stępień KM, Tomaszewska J, et al. Statin-induced myopathies. Pharmacol Rep. 2011; 63(4): 859–866.
  4. Mammen A. Statin-Associated Autoimmune Myopathy. N Engl J Med. 2016; 374(7): 664–669.
  5. Lee G. Exercise-induced rhabdomyolysis. R I Med J (2013). 2014; 97(11): 22–24.
  6. Fitzgerald K, Redmond E, Harbor C. Statin-induced Myopathy. Glob Adv Health Med. 2012; 1(2): 32–36.
  7. Cervellin G, Comelli I, Benatti M, et al. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem. 2017; 50(12): 656–662.
  8. Lott JA, Stang JM. Serum enzymes and isoenzymes in the diagnosis and differential diagnosis of myocardial ischemia and necrosis. Clin Chem. 1980; 26(9): 1241–1250.
  9. Monti DM, De Simone G, Langella E, et al. Insights into the role of reactive sulfhydryl groups of Carbonic Anhydrase III and VII during oxidative damage. J Enzyme Inhib Med Chem. 2017; 32(1): 5–12.
  10. Harju AK, Bootorabi F, Kuuslahti M, et al. Carbonic anhydrase III: a neglected isozyme is stepping into the limelight. J Enzyme Inhib Med Chem. 2013; 28(2): 231–239.
  11. Beuerle JR, Azzazy HM, Styba G, et al. Characteristics of myoglobin, carbonic anhydrase III and the myoglobin/carbonic anhydrase III ratio in trauma, exercise, and myocardial infarction patients. Clin Chim Acta. 2000; 294(1-2): 115–128.
  12. Deska P, Nowicki M. Short-term changes of serum potassium concentration induced by physical exercise in patient with arterial hypertension treated with angiotensin-converting enzyme inhibitor alone or in combination with statin. J Physiol Pharmacol. 2017; 68(1): 133–138.
  13. Feng HZ, Jin JP. Carbonic Anhydrase III Is Expressed in Mouse Skeletal Muscles Independent of Fiber Type-Specific Myofilament Protein Isoforms and Plays a Role in Fatigue Resistance. Front Physiol. 2016; 7: 597.
  14. Väänänen HK, Syrjälä H, Rahkila P, et al. Serum carbonic anhydrase III and myoglobin concentrations in acute myocardial infarction. Clin Chem. 1990; 36(4): 635–638.
  15. Osterman PO, Askmark H, Wistrand PJ. Serum carbonic anhydrase III in neuromuscular disorders and in healthy persons after a long-distance run. J Neurol Sci. 1985; 70(3): 347–357.
  16. Laufs U, Scharnagl H, Halle M, et al. Treatment Options for Statin-Associated Muscle Symptoms. Dtsch Arztebl Int. 2015.
  17. Guidelines for the management of arterial hypertension. www.escardio.org (10.1159/isbn.978-3-318-01088-6).
  18. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2013; 3(1): Suppl.
  19. Manoj K, Jain N, Madhu SV. Myopathy in Patients Taking Atorvastatin: A Pilot Study. Indian J Endocrinol Metab. 2017; 21(4): 504–509.
  20. Khine H, Yuet WC, Adams-Huet B, et al. Statin-associated muscle symptoms and SLCO1B1 rs4149056 genotype in patients with familial hypercholesterolemia. Am Heart J. 2016; 179: 1–9.
  21. Allen SC, Mamotte CDS. Pleiotropic and Adverse Effects of Statins-Do Epigenetics Play a Role? J Pharmacol Exp Ther. 2017; 362(2): 319–326.
  22. Osaki Y, Nakagawa Y, Miyahara S, et al. Skeletal muscle-specific HMG-CoA reductase knockout mice exhibit rhabdomyolysis: A model for statin-induced myopathy. Biochem Biophys Res Commun. 2015; 466(3): 536–540.
  23. Muscal E. Rhabdomyolysis: Practice Essentials, Background, Pathophysiology. Medscape 2015. https://emedicine.medscape.com/article/1007814-overview#showall.
  24. Gautam PL, Luthra N, Nain S. Sports Induced Cardiac Arrest: A Case of Missed Rhabdomyolysis. J Clin Diagn Res. 2015; 9(9): UD01–UD02.
  25. Tunstall Pedoe DS. Marathon cardiac deaths: the London experience. Sports Med. 2007; 37(4-5): 448–450.
  26. Rae DE, Knobel GJ, Mann T, et al. Heatstroke during endurance exercise: is there evidence for excessive endothermy? Med Sci Sports Exerc. 2008; 40(7): 1193–1204.
  27. Sinert R, Kohl L, Rainone T, et al. Exercise-induced rhabdomyolysis. Ann Emerg Med. 1994; 23(6): 1301–1306.
  28. Sliż D, Filipiak KJ, Naruszewicz M, et al. Standards of statin usage in Poland in high-risk patients: 3ST-POL study results. Kardiol Pol. 2013; 71(3): 253–259.
  29. Stroes ES, Thompson PD, Corsini A, et al. European Atherosclerosis Society Consensus Panel. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J. 2015; 36(17): 1012–1022.
  30. Kim M, Chun J, Jung HAh, et al. Capillarisin attenuates exercise-induced muscle damage through MAPK and NF-κB signaling. Phytomedicine. 2017; 32: 30–36.
  31. Callegari GA, Novaes JS, Neto GR, et al. Creatine Kinase and Lactate Dehydrogenase Responses after Different Resistance and Aerobic Exercise Protocols. J Hum Kinet. 2017; 58: 65–72.
  32. Laufs U, Filipiak KJ, Gouni-Berthold I, et al. SAMS expert working group. Practical aspects in the management of statin-associated muscle symptoms (SAMS). Atheroscler Suppl. 2017; 26: 45–55.
  33. Vasilaki A, Simpson D, McArdle F, et al. Formation of 3-nitrotyrosines in carbonic anhydrase III is a sensitive marker of oxidative stress in skeletal muscle. Proteomics Clin Appl. 2007; 1(4): 362–372.
  34. Muscal E. Rhabdomyolysis: Practice Essentials, Background, Pathophysiology. Medscape 2015. https://emedicine.medscape.com/article/1007814-overview#showall.
  35. Sarafidis PA, Blacklock R, Wood E, et al. Prevalence and factors associated with hyperkalemia in predialysis patients followed in a low-clearance clinic. Clin J Am Soc Nephrol. 2012; 7(8): 1234–1241.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl