Blood Pressure Lowering With Nilvadipine in Patients With Mild‐to‐Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension Academic Article uri icon

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abstract

  • 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. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02017340.

authors

  • de Heus, Rianne AA
  • Donders, Rogier
  • Santoso, Angelina MM
  • Olde Rikkert, Marcel GM
  • Lawlor, Brian A
  • Claassen, Jurgen AHR
  • Segurado, Ricardo
  • Howard, Robert
  • Pasquier, Florence
  • Börjesson‐Hanson, Anne
  • Tsolaki, Magda
  • Lucca, Ugo
  • Molloy, Davidwilliam
  • Coen, Robert
  • Riepe, Matthias W
  • Kálmán, János
  • Kenny, Rose Anne
  • Cregg, Fiona
  • O'Dwyer, Sarah
  • Walsh, Cathal
  • Adams, Jessica
  • Banzi, Rita
  • Breuilh, Laetitia
  • Daly, Leslie
  • Hendrix, Suzanne
  • Aisen, Paul
  • Gaynor, Siobhan
  • Sheikhi, Ali
  • Taekema, Diana G
  • Verhey, Frans R
  • Nemni, Raffaello
  • Nobili, Flavio
  • Franceschi, Massimo
  • Frisoni, Giovanni
  • Zanetti, Orazio
  • Konsta, Anastasia
  • Anastasios, Orologas
  • Nenopoulou, Styliani
  • Tsolaki‐Tagaraki, Fani
  • Pakaski, Magdolna
  • Dereeper, Olivier
  • de la Sayette, Vincent
  • Sénéchal, Olivier
  • Lavenu, Isabelle
  • Devendeville, Agnès
  • Calais, Gauthier
  • Crawford, Fiona
  • Mullan, Michael
  • Aalten, Pauline
  • Berglund, Maria A
  • de Jong, Daan LK
  • Godefroy, Olivier
  • Hutchinson, Siobhan
  • Ioannou, Aikaterini
  • Jonsson, Michael
  • Kent, Annette
  • Kern, Jürgen
  • Nemtsas, Petros
  • Panidou, Minoa‐Kalliopi
  • Abdullah, Laila
  • Paris, Daniel
  • van Spijker, Gerrita J
  • Spiliotou, Martha
  • Thomoglou, Georgia
  • Wallin, Anders
  • Gupta, Oliver

publication date

  • May 21, 2019

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