β-Blockers Associated With Slower Huntington Disease Onset and Progression
β-blocker use was associated with delayed motor onset in patients with premanifest Huntington disease (HD) and a slower rate of symptom worsening in patients with early motor-manifest HD, according to study findings published in JAMA Neurology.
“These findings demonstrated that β-blockers may have a therapeutic role in HD but further studies are required,” wrote corresponding author Jordan L. Schultz, PharmD, of the Carver College of Medicine at the University of Iowa, Iowa City, Iowa, and study coauthors.
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Suspecting that β-blockers may uniquely ease overactive sympathetic nervous systems in patients with HD, researchers investigated their impact in patients with premanifest HD and early motor-manifest HD. Specifically, researchers were interested in associations with motor diagnosis onset and progression of HD symptoms.
Investigators used the Enroll-HD platform database to identify 174 patients with genetically confirmed premanifest HD and 149 patients with early motor-manifest HD who used β-blockers for more than a year. Patients were matched to similar patients with the same diagnosis who did not use β-blockers.
In patients with premanifest HD, who had a mean age of 46.4 years, the annualized hazard of receiving a motor diagnosis was significantly decreased with β-blocker use. According to the study, the hazard ratio was 0.66 for a motor diagnosis in β-blocker users compared with nonusers.
In patients with early motor-manifest HD, who had a mean age of 58.9 years, average annualized worsening was slower in patients who used β-blockers. Compared with nonusers, β-blocker users averaged differences of −0.45 in total motor scores, 0.10 in total functional capacity scores, and 0.33 symbol digit modalities test scores, the study found.
Conversely, patient use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was not linked with any significant benefit in HD symptoms, post hoc analyses showed.
“Because β-blockers were associated with a decreased annualized risk of receiving a motor diagnosis of HD and slower worsening of symptoms in premanifest HD and participants with motor-manifest HD and ACEI/ARBs were not, we hypothesize that noradrenergic transmission may play a role,” the authors wrote. “However, this is beyond the scope of this article and further studies would be required to confirm this hypothesis.”
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