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.

引用

页数：24

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