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Dihydropyridine calcium channel blockers and the progression of parkinsonism
Author(s) -
Marras Connie,
Gruneir Andrea,
Rochon Paula,
Wang Xuesong,
Anderson Geoff,
Brotchie Jonathan,
Bell Chaim M.,
Fox Susan,
Austin Peter C.
Publication year - 2012
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.22616
Subject(s) - parkinsonism , dihydropyridine , medicine , nifedipine , hazard ratio , amlodipine , calcium channel , cohort , calcium channel blocker , confidence interval , anesthesia , disease , calcium , blood pressure
Objective: A study was undertaken to test the association between dihydropyridine calcium channel blocker use and the time to important milestones of disease progression among patients with parkinsonism. Methods: Data were obtained from Ontario's health care administrative databases. Within a cohort of hypertensive individuals older than 65 years who developed parkinsonism, we examined the effect of the length of exposure to less brain‐penetrant dihydropyridines (amlodipine) and more brain‐penetrant dihydropyridines (eg, nifedipine, felodipine) on parkinsonism milestones as measured by time to requiring drug treatment for parkinsonism, nursing home admission, and death. Results: Among 4,733 hypertensive individuals with parkinsonism, longer treatment with any dihydropyridine was associated with a decreased risk of each of the 3 outcomes. There was no difference, however, between amlodipine (adjusted hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.42–0.50 for initiation of drug treatment; HR, 0.68; 95% CI, 0.63–0.73 for application for nursing home admission; and HR, 0.75; 95% CI, 0.70–0.80 for death) and nonamlodipine dihydropyridines (adjusted HRs [95% CIs], 0.45 [0.39–0.53], 0.74 [0.67–0.81], and 0.74 [0.64–0.85] for the 3 milestones, respectively). Interpretation: We found no specific beneficial effect of treatment with brain‐penetrant dihydropyridines on delaying parkinsonism progression milestones. Dihydropyridine calcium channel blockers are unlikely to have a clinically significant effect on the course of parkinsonism, particularly Parkinson disease, in the doses used to treat hypertension. ANN NEUROL 2012;