Objective: We explored the associations between markers of clinical decline and antihypertensive use in subjects with both Parkinson disease (PD) and hypertension (HTN)

Background: Comorbid HTN is present in about 1/3 of people with PD and is a risk factor for microvascular brain injury and axial motor impairment. Antihypertensive medications have the potential to reduce this risk but also carry their own fall-related risks by exacerbating PD orthostatic-features.

Methods: Using data from the Parkinson’s Progression Markers Initiative (PPMI, n=400), we conducted a Cox proportional hazard analysis testing associations between baseline antihypertensive use in PD subjects and PD-milestones characterizing disease progression. We defined an aggregate milestone outcome as having been met if a subject reached any one of the following during the study: declining to a Montreal Cognitive Assessment (MoCA) score of 20, declining to Schwab an England score of <80, or progressing to a Hoehn and Yahr score of 3. We controlled for orthostatic hypotension, defined as systolic blood pressure (SBP) decline between seated and standing positions at the baseline visit. HTN status was defined as the mean of supine SBPs at the screening and baseline visits. Antihypertension medication use was defined as a binary categorical variable at the time of baseline visit. We used an interaction term between (+) HTN status and (+) antihypertension medication use to estimate an antihypertensive-medication-effect in those with PD and HTN.

Results: 109/400 (27.5%) of the cohort had mean SBPs of 140mmHg at study entry. 86 subjects (21.5%) progressed to a PD-milestone outcome during the study. In a Cox-proportional hazard analysis, the interaction term between (+) antihypertension medication use and systolic hypertension ( 140mmHg) showed a protective effect (HR=0.370 95% CI: 0.144, 0.949; z=-2.07, p=0.039) even after adjusting for orthostatic blood pressure decline. In a sensitivity analyses using the same covariates and interaction terms, this (+)-antihypertensive-medication-(+)HTN status interaction term showed a protective effect when the categorization of HTN status was changed to a mean SBP of 150mmHg (HR=0.165 95% CI: 0.032, 0.846; z=-2.16, p=0.031) but not at SBP 130mmHg (HR=0.827 95% CI: 0.346, 1.978; z=-0.43, p=0.670).

Conclusions: The use of antihypertensive medications in hypertensive individuals with PD may protect against unfavorable PD-related outcomes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antihypertensive-medications-have-protective-associations-with-pd-outcomes-in-pd-hypertension/