共 60 条
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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