Objective: To determine the effect of different classes of antihypertensive medications on Parkinson’s disease progression.

Background: Cardiovascular risk factors such as hypertension can worsen Parkinson’s disease progression. Limited data suggests that different classes of antihypertensive agents may have distinct effects on Parkinson’s disease pathophysiology and progression: beta blockers are associated with increased risk of developing PD, while angiotensin converting enzyme inhibitors and angiotensin receptor blockers reduce the occurrence of levodopa-induced dyskinesia via their effect on the nigrostriatal pathways [1,2]. We assessed how the use of different antihypertensive agents impacts the trajectory of motor, cognitive, and autonomic manifestations of Parkinson’s disease.

Method: We included Parkinson’s disease patients with hypertension taking a single antihypertensive medication in the Parkinson’s Progression Markers Initiative (PPMI) dataset. We divided the data into five cohorts corresponding to patients prescribed angiotensin converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARB), beta blockers (BB), calcium channel blockers (CCB), and thiazide diuretics (TZ). Motor, cognitive, and autonomic progression was evaluated via MDS-UPDRS III subscore, MoCA, and SCOPA-AUT questions 14-16 addressing orthostasis, respectively. Participants with fewer than two follow up evaluations were excluded. The Kruskal-Wallis test and ANOVA tests were used to compare score differences between the cohorts at baseline and annual visits from years 1 to 5.

Results: 1431 Parkinson’s disease patients had longitudinal data available; 564 were prescribed anti-hypertensives; 492 were prescribed a single anti-hypertensive agent: ACE 100, ARB 57, BB 144, CCB 84, TZ 45. 66% were male; mean age was 64.7 years. There was no statistically significant differences across the five cohorts in progression of MDS-UPDRS III, MoCA, or SCOPA-AUT scores.

Conclusion: We found no significant impact of different antihypertensive medications on the progression of motor, cognitive, or autonomic manifestations of Parkinson’s disease. This study suggest that the use of commonly prescribed antihypertensive classes is generally safe and equivalent from a Parkinson’s disease standpoint. However, these conclusions are limited by data set size and further study will be needed to confirm our findings.

References: [1] Contaldi E, Magistrelli L, Milner AV, Cosentino M, Marino F, Comi C. “Potential protective role of ACE-inhibitors and AT1 receptor blockers against levodopa-induced dyskinesias: a retrospective case-control study.” Neural Regen Res. 2021;16(12):2475-2478. doi:10.4103/1673-5374.313061 https://pmc.ncbi.nlm.nih.gov/articles/PMC8374578/

[2] Feng, Z., Zhao, Q., Wu, J. et al. “Nonselective beta-adrenoceptor blocker use and risk of Parkinson’s disease: from multiple real-world evidence.”

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-antihypertensive-agent-choice-on-parkinsons-disease-progression-in-patients-with-hypertension/