Division of Neurology, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada.
Ann Neurol. 2012 Mar;71(3):362-9. doi: 10.1002/ana.22616.
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.
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.
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).
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.
本研究旨在检验二氢吡啶类钙通道阻滞剂的使用与帕金森病患者疾病进展重要里程碑之间的关联。
数据来源于安大略省的医疗保健管理数据库。在一个年龄大于 65 岁且患有帕金森病的高血压患者队列中，我们研究了较少穿透血脑屏障的二氢吡啶类药物（氨氯地平）和更多穿透血脑屏障的二氢吡啶类药物（如硝苯地平、非洛地平）的暴露时间对帕金森病里程碑的影响，这些里程碑通过帕金森病需要药物治疗、入住疗养院和死亡的时间来衡量。
在 4733 名患有帕金森病的高血压患者中，使用任何二氢吡啶类药物的时间较长与这 3 种结局的风险降低均相关。然而，氨氯地平（起始药物治疗的调整后的危害比 [HR]，0.46；95%置信区间 [CI]，0.42-0.50；申请入住疗养院的 HR，0.68；95%CI，0.63-0.73；以及死亡的 HR，0.75；95%CI，0.70-0.80）与非氨氯地平二氢吡啶类药物（调整后的 HR [95%CI]，0.45 [0.39-0.53]、0.74 [0.67-0.81] 和 0.74 [0.64-0.85]）之间没有差异。
我们没有发现穿透血脑屏障的二氢吡啶类药物治疗对延迟帕金森病进展里程碑有特定的有益作用。在用于治疗高血压的剂量下，二氢吡啶类钙通道阻滞剂不太可能对帕金森病，特别是帕金森病的病程产生显著的临床影响。
