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

Artikel i vetenskaplig tidskrift
Författare R. A. A. de Heus
R. Donders
A. M. M. Santoso
Mgmo Rikkert
B. A. Lawlor
Jahr Claassen
R. Segurado
S. Kennelly
R. Howard
F. Pasquier
Anne Börjesson-Hanson
M. Tsolaki
U. Lucca
D. W. Molloy
R. Coen
M. W. Riepe
J. Kalman
R. A. Kenny
F. Cregg
S. O'Dwyer
C. Walsh
J. Adams
R. Banzi
L. Breuilh
L. Daly
S. Hendrix
P. Aisen
S. Gaynor
A. Sheikhi
D. G. Taekema
F. R. Verhey
R. Nemni
F. Nobili
M. Franceschi
O. Zanetti
A. Konsta
O. Anastasios
S. Nenopoulou
F. Tsolaki-Tagarak
M. Pakaski
O. Dereeper
V. de la Sayette
O. Senechal
I. Lavenu
A. Devendeville
G. Calais
F. Crawford
M. Mullan
P. Aalten
M. A. Berglund
D. L. K. de Jong
O. Godefroy
S. Hutchinso
A. Loannou
Michael Jonsson
A. Kent
Jürgen Kern
P. Nemtsas
M. K. Panidou
L. Abdullah
D. Paris
G. J. van Spijker
M. Spiliotou
G. Thomoglou
Anders Wallin
G. Frisoni
Grp Nilvad Study
Publicerad i Journal of the American Heart Association
Volym 8
Nummer/häfte 10
ISSN 2047-9980
Publiceringsår 2019
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för psykiatri och neurokemi
Språk en
Länkar dx.doi.org/10.1161/jaha.119.011938
Ämnesord adverse drug event, Alzheimer disease, antihypertensive agent, calcium channel blocker, orthostatic, antihypertensive treatment, cognitive impairment, consensus statement, cardiovascular risk, european-society, hypertension, association, management, older, dementia
Ämneskategorier Klinisk medicin

Sammanfattning

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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