title: Antihypertensive therapy is associated with reduced rate of conversion to Alzheimer's disease in midregional proatrial natriuretic peptide stratified subjects with mild cognitive impairment.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Alzheimer Memorial Center, Department of Psychiatry, Klinikum Grosshadern, Ludwig-Maximilian University, Munich, Germany. philine.schneider@med.uni-muenchen.de
authors: Philine
authors: P
authors: Schneider
authors: Katharina
authors: K
authors: Buerger
authors: Stefan
authors: S
authors: Teipel
authors: Olga
authors: O
authors: Uspenskaya
authors: Oliver
authors: O
authors: Hartmann
authors: Oskar
authors: O
authors: Hansson
authors: Lennart
authors: L
authors: Minthon
authors: Dan
authors: D
authors: Rujescu
authors: Hans-Juergen
authors: HJ
authors: Moeller
authors: Henrik
authors: H
authors: Zetterberg
authors: Kaj
authors: K
authors: Blennow
authors: Andrea
authors: A
authors: Ernst
authors: Andreas
authors: A
authors: Bergmann
authors: Harald
authors: H
authors: Hampel
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000209:etiology*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D009320:Atrial Natriuretic Factor / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects; D003072:Cognition Disorders / Q000378:metabolism* / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents; D009320:Atrial Natriuretic Factor