Abstract
Background. Antihypertensive agents have been shown to inhibit oxidative stress and inflammatory response and thus neuroprotection in Parkinson's disease (PD). Epidemiological evidence suggests inconsistency between use of antihypertensives and risk of PD. This study is aimed to examine the association between antihypertensive use and risk of PD. Methods. Literature search in PubMed, EMBASE, and PsycINFO database was undertaken through February 2012 looking for observational studies evaluating the association between antihypertensive drug use and risk of PD. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects model (DerSimonian and Laird method). Subgroup analyses and sensitivity analysis were also performed. Results. Seven relevant studies including a total of 28,32,991 subjects were included. Pooled RR of overall use of antihypertensive agents was found to be 0.95 (95% CI 0.84–1.05). A significant reduction in the risk of PD was observed among users of calcium channel blockers (RR 0.82, 95% CI 0.71–0.93). Significant heterogeneity (I 2 = 76.2%) but no publication bias was observed. Conclusions. Overall use of antihypertensive agents showed no significant association with the risk of PD. CCBs provided significant protective role. However, studies with large sample size and dose relationships are required to strengthen our hypothesis.
Highlights
Parkinson’s disease (PD) is the most common neurodegenerative disorder, which is more prevalent in elderly population [1]
Evidence from preclinical studies showed that calcium channel blockers (CCBs), beta blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) may have neuroprotective effect by inhibiting calcium overload, nitric oxide, reactive oxygen species (ROS), tumor necrosis factor-α, and interleukin1 β synthesis which are responsible for neurotoxicity and degeneration of dopaminergic neurons [3]
Further screening of 407 articles has shown that search results included animal models, uncontrolled and nonrandomized trials, reviews, and case series and reports which were excluded (n = 350). 57 studies were read as full papers
Summary
Parkinson’s disease (PD) is the most common neurodegenerative disorder, which is more prevalent in elderly population [1]. Antihypertensive agents majorly include calcium channel blockers (CCBs), beta blockers, angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin II receptor blockers (ARBs). These drugs are used to treat hypertension and cardiovascular diseases [4]. Evidence from preclinical studies showed that CCBs, beta blockers, ACE inhibitors, and ARBs may have neuroprotective effect by inhibiting calcium overload, nitric oxide, reactive oxygen species (ROS), tumor necrosis factor-α, and interleukin β synthesis which are responsible for neurotoxicity and degeneration of dopaminergic neurons [3]. Overall use of antihypertensive agents showed no significant association with the risk of PD. Studies with large sample size and dose relationships are required to strengthen our hypothesis
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