Use of antihypertensives and the risk of Parkinson disease

Abstract

Background: Recent studies related angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers to possible neuroprotective effects. Little is known about neuroprotection of angiotensin II (AT II) antagonists or beta-blockers. Objective: To explore the association between antihypertensive drug use and the risk of developing a first-time diagnosis of Parkinson disease (PD). Methods: This was a case-control analysis within the UK-based General Practice Research Database. Cases were ≥40 years of age with an incident PD diagnosis between 1994 and 2005. We matched one control to each PD case on age, sex, general practice, index date, and duration of previous history in the database. We assessed antihypertensive drug use by timing and by exposure duration. We calculated ORs using conditional logistic regression, adjusted for body mass index, smoking, and various cardiovascular, metabolic, and psychiatric diseases and dementia. Results: We identified 3,637 cases with a first-time diagnosis of idiopathic PD and an equal number of matched controls. As compared to nonuse of antihypertensive drugs, the adjusted OR for current use of ≥30 prescriptions was 1.08 (95% CI 0.85 to 1.37) for ACE inhibitors, 0.91 (95% CI 0.41 to 2.00) for AT II antagonists, 1.16 (95% CI 0.95 to 1.41) for beta-blockers, and 0.77 (95% CI 0.63 to 0.95) for calcium channel blockers. Conclusions: Current long-term use of calcium channel blockers was associated with a significantly reduced risk of a Parkinson disease diagnosis, while the risk was not materially altered for users of angiotensin converting enzyme inhibitors or beta-blockers and, with less statistical precision, for users of angiotensin II antagonists. GLOSSARY: ACE = angiotensin converting enzyme; AD = Alzheimer disease; AT II = angiotensin II; BMI = body mass index; CHF = congestive heart failure; COMT = catechol-O-methyltransferase; COPD = chronic obstructive pulmonary disease; GP = general practitioner; GPRD = General Practice Research Database; IHD = ischemic heart disease; ISAC = Independent Scientific Advisory Committee; MHRA = Medicines and Healthcare products Regulatory Agency; OXMIS = Oxford Medical Information System; PD = Parkinson disease; TIA = transient ischemic attack.