Further evidence has come from observational studies in hypertensive cohorts where treatment with an ACE inhibitor has been associated with increased locomotor muscle size16 and strength.17 This is supported by randomized controlled trials where ACE inhibition has increased 6-min walking distance in elderly subjects18 and angiotensin II receptor blockade has shown a trend toward an improvement in quadriceps strength in subjects with COPD.19 This evidence concerns the gene ACE and chronic obstructive pulmonary disease.