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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

Rianne A. A. De Heus Rogier Donders Angelina M. M. Santoso Marcel G. M. Olde Rikkert Brian A. Lawlor Jurgen A. H. R. Claassen 1 Ricardo Segurado 2 Sean Kennelly Robert Howard 3 Florence Pasquier 4 Anne Borjesson-Hanson Magda Tsolaki 5 Ugo Lucca 6 D. William Molloy Robert Coen Matthias W. Riepe Janos Kalman Rose Anne Kenny Fiona Cregg Sarah O'Dwyer Cathal Walsh Jessica Adams Rita Banzi 7 Laetitia Breuilh Leslie Daly Suzanne Hendrix Paul Aisen 8 Siobhan Gaynor 9 Ali Sheikhi Diana G. Taekema Frans R. Verhey Raffaello Nemni 10 Flavio Nobili 11 Massimo Franceschi 12 Orazio Zanetti 13 Anastasia Konsta Orologas Anastasios Styliani Nenopoulou Fani Tsolaki-Tagarak Magdolna Pakaski Olivier Dereeper Vincent de La Sayette Olivier Senechal 14 Isabelle Lavenu Agnes Devendeville Gauthier Calais Fiona Crawford Michael Mullan Pauline Aalten 15 Maria A. Berglund Daan L. K. De Jong Olivier Godefroy 16 Siobhan Hutchinso Aikaterini Loannou Michael Jonsson Annette Kent Jurgen Kern Petros Nemtsas Minoa-Kalliopi Panidou Laila Abdullah Daniel Paris Gerrita J. Van Spijker Martha Spiliotou Georgia Thomoglou Anders Wallin 17 Giovanni Frisoni 18, 19 
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.
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Soumis le : samedi 12 mars 2022 - 14:19:11
Dernière modification le : mercredi 24 août 2022 - 10:12:23

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Rianne A. A. De Heus, Rogier Donders, Angelina M. M. Santoso, Marcel G. M. Olde Rikkert, Brian A. Lawlor, et al.. Blood Pressure Lowering With Nilvadipine in Patients With Mild-to-Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension. Journal of the American Heart Association, Wiley-Blackwell, 2019, 8 (10), ⟨10.1161/JAHA.119.011938⟩. ⟨hal-03606872⟩



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