NT-proBNP, blood pressure, and cognitive decline in the oldest old The Leiden 85-plus Study

作者：van Vliet Peter^*; Sabayan Behnam; Wijsman Liselotte W; Poortvliet Rosalinde K E; Mooijaart Simon P; de Ruijter Wouter; Gussekloo Jacobijn; de Craen Anton J M; Westendorp R G J

来源：Neurology, 2014, 83(13): 1192-1199.

DOI：10.1212/wnl.0000000000000820

Objective: To study the relation between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, used as a marker of heart failure in clinical practice, blood pressure (BP), and cognitive decline in the oldest old.
Methods: In 560 participants of the Leiden 85-plus Study, we measured NT-proBNP levels and BP at age 85 years, at baseline, and global cognitive Mini-Mental State Examination [MMSE]) annually during the follow-up of 5 years.
Results: Subjects in the highest tertile of NT-proBNP levels scored 1.7 points lower on the MMSE at age 85 years than subjects in the lowest tertile (p = 0.004), and had a 0.24-point-steeper decline in MMSE score per year (p = 0.021). The longitudinal association disappeared after full adjustment for possible confounders (0.14-point-steeper decline, p = 0.187). Subjects in the category "highest tertile of NT-proBNP and the lowest tertile of systolic BP" had a 3.7-point-lower MMSE score at baseline (p < 0.001) and a 0.49-point-steeper decline in MMSE score per year (p < 0.001) compared with subjects in the other categories.
Conclusions: In the oldest old, high NT-proBNP levels are associated with lower MMSE scores. The combination of high NT-proBNP levels and low systolic BP is associated with worst global cognitive function and the steepest cognitive decline. Possibly, a failing pump function of the heart results in lower BP and lower brain perfusion with resultant brain dysfunction.

• 出版日期2014-9-23