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*, Ricardo Segurado, Sean Kennelly, Robert Howard, Florence Pasquier, Anne Borjesson-Hanson, Magda Tsolaki, Ugo Lucca, D. William Molloy, Robert Coen, Matthias W. Riepe, Janos Kalman, Rose Anne Kenny, Fiona Cregg, Sarah O'DwyerCathal Walsh, Jessica Adams, Rita Banzi, Laetitia Breuilh, Leslie Daly, Suzanne Hendrix, Paul Aisen, Siobhan Gaynor, Ali Sheikhi, Diana G. Taekema, Frans R. Verhey, Raffaello Nemni, Flavio Nobili, Massimo Franceschi, Orazio Zanetti, Anastasia Konsta, Orologas Anastasios, Styliani Nenopoulou, Fani Tsolaki-Tagarak, Magdolna Pakaski, Olivier Dereeper, Vincent de la Sayette, Olivier Senechal, Isabelle Lavenu, Agnes Devendeville, Gauthier Calais, Fiona Crawford, Michael Mullan, Pauline Aalten, Maria A. Berglund, NILVAD Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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

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.

Original languageEnglish
Article number011938
Number of pages24
JournalJournal of the American Heart Association
Issue number10
Publication statusPublished - 21 May 2019


  • adverse drug event
  • Alzheimer disease
  • antihypertensive agent
  • calcium channel blocker
  • orthostatic hypotension
  • randomized controlled trial


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