Blood Pressure Lowering With Nilvadipine in Patients With Mild-to-Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension

被引:11
作者
de Heus, Rianne A. A. [1 ,2 ]
Donders, Rogier [3 ]
Santoso, Angelina M. M. [1 ,2 ]
Rikkert, Marcel G. M. Olde [1 ,2 ]
Lawlor, Brian A. [4 ,5 ]
Claassen, Jurgen A. H. R. [1 ,2 ]
Segurado, Ricardo [6 ,7 ]
Kennelly, Sean [8 ,9 ]
Howard, Robert [10 ,11 ]
Pasquier, Florence [12 ]
Borjesson-Hanson, Anne [13 ]
Tsolaki, Magda [14 ]
Lucca, Ugo [15 ]
Molloy, D. William [16 ]
Coen, Robert [4 ]
Riepe, Matthias W. [17 ]
Kalman, Janos [18 ]
Kenny, Rose Anne [19 ]
Cregg, Fiona [19 ]
O'Dwyer, Sarah [4 ]
Walsh, Cathal [20 ,21 ]
Adams, Jessica [22 ]
Banzi, Rita [15 ]
Breuilh, Laetitia [12 ]
Daly, Leslie [6 ,7 ]
Hendrix, Suzanne [23 ]
Aisen, Paul [24 ]
Gaynor, Siobhan [25 ]
Sheikhi, Ali [20 ,21 ]
Taekema, Diana G. [26 ]
Verhey, Frans R. [27 ]
Nemni, Raffaello [28 ]
Nobili, Flavio [29 ,30 ]
Franceschi, Massimo [31 ]
Zanetti, Orazio [32 ]
Konsta, Anastasia [33 ]
Anastasios, Orologas [34 ]
Nenopoulou, Styliani [14 ]
Tsolaki-Tagarak, Fani [14 ]
Pakaski, Magdolna [18 ]
Dereeper, Olivier [35 ]
de la Sayette, Vincent [36 ]
Senechal, Olivier [37 ]
Lavenu, Isabelle [38 ]
Devendeville, Agnes [39 ]
Calais, Gauthier [40 ]
Crawford, Fiona [41 ,42 ]
Mullan, Michael [27 ,41 ,42 ]
Aalten, Pauline [43 ]
Berglund, Maria A. [44 ]
机构
[1] Radboud Univ Nijmegen, Med Ctr, Dept Geriatr Med, Donders Inst Brain Cognit & Behav, Nijmegen, Netherlands
[2] Radboudumc, Alzheimer Ctr, Nijmegen, Netherlands
[3] Radboud Univ Nijmegen, Dept Hlth Evidence, Med Ctr, Nijmegen, Netherlands
[4] St James Hosp, Mercers Inst Res Ageing, Dublin, Ireland
[5] Trinity Coll Dublin, Dept Med Gerontol, Inst Neurosci, Dublin, Ireland
[6] Univ Coll Dublin, CSTAR, Dublin, Ireland
[7] Univ Coll Dublin, Sch Publ Hlth Physiotherapy & Sport Sci, Dublin, Ireland
[8] Tallaght Hosp, Dept Age Related Healthcare, Dublin 24, Ireland
[9] Trinity Coll Dublin, Dept Med Gerontol, Dublin, Ireland
[10] UCL, Div Psychiat, London, England
[11] Kings Coll London, London, England
[12] Univ Lille, DISTALZ Lab Excellence, CHU Lille, F-59000 Lille, France
[13] Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Gothenburg, Sweden
[14] Papanikolaou Gen Hosp Thessaloniki, Pilea Chortiatis, Greece
[15] Ist Ric Farmacol Mario Negri, Lab Geriatr Neuropsychiat, IRCCS, Milan, Italy
[16] Univ Coll Cork, Ctr Gerontol & Rehabil, Cork, Ireland
[17] Ulm Univ BKH Gunzburg, Dept Geriatr & Old Age Psychiat, Psychiat 2, Ulm, Germany
[18] Univ Szeged, Dept Psychiat, Szeged, Hungary
[19] TCD, Dept Med Gerontol, Dublin, Ireland
[20] Univ Limerick, Hlth Res Inst, Dept Math & Stat, Limerick, Ireland
[21] Univ Limerick, MACSI, Dept Math & Stat, Limerick, Ireland
[22] Kings Coll London, Dept Old Age Psychiat, London, England
[23] Pentara Corp, 2180 Claybourne Ave, Salt Lake City, UT 84109 USA
[24] Univ Southern Calif, Dept Neurol, Los Angeles, CA USA
[25] MMI, Dublin, Ireland
[26] Rijnstate Hosp, Dept Geriatr Med, Arnhem, Netherlands
[27] Maastricht Univ, Alzheimer Ctr Limburg, Sch Mental Hlth & Neurosci, Dept Psychiat & Neuropsychol, Maastricht, Netherlands
[28] Univ Milan, IRCCS Don Gnocchi Fdn, Milan, Italy
[29] Univ Genoa, Dept Neurosci DINOGMI, Genoa, Italy
[30] Hosp San Martino, IRCCS AOU Polyclin, Genoa, Italy
[31] Multimedica, Neurol Dept, Castellanza, Italy
[32] Ctr San Giovanni Dio IRCCS Fatebenefratelli, Brescia, Italy
[33] Aristotle Univ Thessaloniki AUTH, Papageorgiou Gen Hosp, Psychiat Dept 1, Thessaloniki, Greece
[34] Ahepa Univ, Gen Hosp Thessaloniki, Thessaloniki, Greece
[35] Ctr Hosp Calais, Calais, France
[36] CHU Caen, Caen, France
[37] Ctr Hosp Lens, Lens, France
[38] Ctr Hosp Bethune, Beuvry, France
[39] CHU Amiens, Amiens, France
[40] GHICL, Lille, France
[41] Archer Pharmaceut Inc, 2040 Whitfield Ave, Sarasota, FL USA
[42] Roskamp Inst, Sarasota, FL USA
[43] Maastricht Univ, Alzheimer Ctr Limburg, Sch Mental Hlth & Neuro Sci, Dept Psychiat & Neuropsychol, Maastricht, Netherlands
[44] Sahlgrens Univ Hosp, Gotheburg, Sweden
[45] Radboud Univ Nijmegen, Med Ctr, Donders Inst Brain Cognit & Behav, Dept Geriatr Med,Radboud Alzheimer Ctr, Nijmegen, Netherlands
[46] St James Hosp, Dublin, Ireland
[47] Aristotle Univ Thessaloniki, Ahepa Univ, Dept Neurol 1, Gen Hosp, Thessaloniki, Greece
[48] TCD, Dublin, Ireland
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2019年 / 8卷 / 10期
关键词
adverse drug event; Alzheimer disease; antihypertensive agent; calcium channel blocker; orthostatic hypotension; randomized controlled trial; ANTIHYPERTENSIVE TREATMENT; COGNITIVE IMPAIRMENT; CONSENSUS STATEMENT; CARDIOVASCULAR RISK; EUROPEAN-SOCIETY; HYPERTENSION; ASSOCIATION; MANAGEMENT; OLDER; DEMENTIA;
D O I
10.1161/JAHA.119.011938
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Hypertension is common among patients with Alzheimer disease. Because this group has been excluded from hypertension trials, evidence regarding safety of treatment is lacking. This secondary analysis of a randomized controlled trial assessed whether antihypertensive treatment increases the prevalence of orthostatic hypotension (OH) in patients with Alzheimer disease. Methods and Results-Four hundred seventy-seven patients with mild-to-moderate Alzheimer disease were randomized to the calcium-channel blocker nilvadipine 8 mg/day or placebo for 78 weeks. Presence of OH (blood pressure drop >= 20/>= 10 mm Hg after 1 minute of standing) and OH-related adverse events (dizziness, syncope, falls, and fractures) was determined at 7 follow-up visits. Mean age of the study population was 72.2 +/- 8.2 years and mean Mini-Mental State Examination score was 20.4 +/- 3.8. Baseline blood pressure was 137.8 +/- 14.0/77.0 +/- 8.6 mm Hg. Grade I hypertension was present in 53.4% (n=255). After 13 weeks, blood pressure had fallen by -7.8/-3.9 mm Hg for nilvadipine and by -0.4/-0.8 mm Hg for placebo (P<0.001). Across the 78-week intervention period, there was no difference between groups in the proportion of patients with OH at a study visit (odds ratio [95% CI] 1.1 [0.8-1.5], P 0.62), nor in the proportion of visits where a patient met criteria for OH, corrected for number of visits (7.7 +/- 13.8% versus 7.3 +/- 11.6%). OH-related adverse events were not more often reported in the intervention group compared with placebo. Results were similar for those with baseline hypertension. Conclusions-This study suggests that initiation of a low dose of antihypertensive treatment does not significantly increase the risk of OH in patients with mild-to-moderate Alzheimer disease.
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页数:24
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