Nilvadipine Lowers BP, Without Increasing Risk of Orthostatic Hypotension in Patients With Alzheimer’s Disease: Presented at ESH

By Chris Berrie

BARCELONA, Spain -- June 13, 2018 -- Nilvadipine lowers blood pressure (BP) without increasing the risk of orthostatic hypotension in patients with mild to moderate Alzheimer’s disease, according to a study presented here at 28th Scientific Meeting of the European Society of Hypertension (ESH).

“This contradicts the view that antihypertensive treatment in patients with Alzheimer’s disease is associated with an excessive risk of orthostatic hypotension,” reported Rianne de Heus, MD, Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands, and colleagues.

The double-blind, placebo-controlled phase 3 NILVAD trial randomised patients with mild to moderate Alzheimer’s disease to receive nilvadipine 8 mg (n = 240) or placebo (n = 237) for 78 weeks.

Compared with placebo, patients receiving nilvadipine had significantly greater decreases in systolic and diastolic BP (P< .001 for both), which were maximal around 13 weeks, and remained low for the duration of the treatment.

With classic orthostatic hypotension defined as ≥20 mmHg drop in SBP or ≥10 mmHg drop in DBP, this was seen for a relatively constant proportion of patients independent of treatment.

At baseline, the prevalence of orthostatic hypotension -- defined as ≥20 mm Hg decrease in systolic BP or ≥10 mm Hg decrease in diastolic BP -- was 8%. Thought the duration of the study, the prevalence remained low at around 10% (odds ratio [OR] = 1.10; P = .62).

Considering the sit-stand definition of orthostatic hypotension of ≥15 mm Hg decrease in systolic BP or ≥7 mm Hg decrease in diastolic BP, results were similar (OR = 1.2; P = .26).

“Over time, there was no difference between the groups,” said Dr. de Heus.

There were no differences between groups for falls (14.8% vs 14.6%), syncope (4.6% vs 5.0%), and dizziness (10.5% vs 10.0).

“These results imply that, with respect to orthostatic hypotension, it would be safe to prescribe antihypertensives to patients with Alzheimer’s disease,” said Dr. de Heus.

[Presentation title: Effect of the Calcium-Channel Blocker Nilvadipine on Orthostatic Hypotension in Patients With Alzheimer’s Disease: Secondary Analysis of a Clinical Trial. Oral Session 4C]

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