Antihypertensive Therapy Is Associated with Reduced Rate of Conversion to Alzheimer's Disease in Midregional Proatrial Natriuretic Peptide Stratified Subjects with Mild Cognitive Impairment

• Published in: Biological psychiatry (1969) Vol. 70; no. 2; pp. 145 - 151
• Main Authors: Schneider, Philine, Buerger, Katharina, Teipel, Stefan, Uspenskaya, Olga, Hartmann, Oliver, Hansson, Oskar, Minthon, Lennart, Rujescu, Dan, Moeller, Hans-Juergen, Zetterberg, Henrik, Blennow, Kaj, Ernst, Andrea, Bergmann, Andreas, Hampel, Harald
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2011; Elsevier
• Subjects: adverse effects; Aged; Alzheimer Disease; Alzheimer Disease - etiology; Alzheimer's disease; antihypertensive; Antihypertensive Agents; Antihypertensive Agents - adverse effects; antihypertensive therapy; antihypertensive treatment; Atrial Natriuretic Factor; Atrial Natriuretic Factor - metabolism; Blood Pressure; Blood Pressure - drug effects; Clinical Medicine; Cognition Disorders; Cognition Disorders - metabolism; Cognition Disorders - physiopathology; Disease Progression; drug effects; drug therapy; etiology; Female; Humans; Hypertension; Hypertension - drug therapy; Kaplan-Meier Estimate; Klinisk medicin; Longitudinal Studies; Male; Medical and Health Sciences; Medicin och hälsovetenskap; metabolism; microcirculatory function; Middle Aged; mild cognitive impairment; MR-proANP; Neurologi; Neurology; physiopathology; Psychiatry; Psykiatri; Regression Analysis; Retrospective Studies; treatment; microcirculatory function; MR-proANP; mild cognitive impairment; antihypertensive therapy; antihypertensive treatment; Alzheimer's disease
• ISSN: 0006-3223; 1873-2402; 1873-2402
• DOI: 10.1016/j.biopsych.2011.01.036

Hypertension is a major risk factor of Alzheimer's disease (AD); however, controlled studies on the effect of antihypertensive treatment on the risk of dementia are inconclusive. Therefore, a biological marker that predicts individual response to antihypertensive treatment would be of high clinical relevance. Midregional proatrial natriuretic peptide (MR-proANP), an inactive surrogate molecule of the mature atrial natriuretic peptide, is related to circulatory function and hypertension. A sample population of 134 subjects with mild cognitive impairment (MCI) was followed for up to 6 years. Multivariable Cox regression analysis was conducted to predict conversion to AD based on all relevant variables. Baseline MR-proANP was significantly increased in the AD converter group ( p < .0001). The conversion rate of patients treated with antihypertensive drugs was significantly reduced only in patients with elevated MR-proANP at baseline ( p = .046). Using an optimized MR-proANP cutoff of 74 pmol/L, representing a value in the upper normal range, treatment with antihypertensive drugs reduced the conversion rate to AD by 36% ( p = .035) for patients with levels >74 pmol/L. Further subgrouping by age (>/≤ 72 years at baseline) increased the positive correlation of antihypertensive treatment and MCI outcome for patients below the age of 72 years (conversion rate reduced by 74%, p = .016). These data seem to support the notion of a potential impact of circulatory function for the prognosis of AD at a prodromal stage. The MR-proANP levels may be useful to predict the effect of antihypertensive treatment on conversion rates to AD in subjects with MCI.