Improving Blood Pressure Screening and Treatment Strategies in Young Adults

改善年轻人的血压筛查和治疗策略

• 批准号: 10276161
• 负责人: Jaejin An
• 金额: $ 78.54万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10276161
• 关键词: Address; Adverse event; Advisory Committees; African American; Age; Antihypertensive Agents; Blood Pressure; California; Cardiovascular Diseases; Characteristics; Chronic Kidney Failure; Clinical; Coronary heart disease; Data; Databases; Diabetes Mellitus; Disease Outcome; Early Diagnosis; Early treatment; Elderly; Electronic Health Record; Epidemiology; Event; Future; Goals; Guidelines; Health; Heart failure; High Prevalence; Hypertension; Individual; Intervention; Kidney; Left; Life; Microalbuminuria; Myocardial Infarction; Obesity; Observational Study; Organ; Outcome; Overweight; Patients; Pharmaceutical Preparations; Pharmacology; Policy Maker; Population; Prevalence; Preventive service; Productivity; Quality of life; Race; Randomized Controlled Trials; Recommendation; Research Priority; Risk; Risk Factors; Risk Reduction; Selection Bias; Statistical Models; Stroke; Subgroup; Syncope; Time; aged; base; blood pressure regulation; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; clinically actionable; clinically relevant; cohort; cost; cost effective; cost efficient; early onset; economic impact; evidence base; follow-up; health economics; health inequalities; healthy aging; high risk; hypertension treatment; improved; premature; prevent; screening; screening guidelines; simulation; social health determinants; treatment risk; treatment strategy; young adult

Project Summary The overall reduction in the rate of cardiovascular disease (CVD) over the past decades in the US has not extended to young adults aged 18-39 years. An increasing prevalence of CVD risk factors in young adults, including high blood pressure (BP), likely contributed to the increase in CVD rates. About 20% of US young adults have stage 1 or 2 hypertension (BP 130-139/80-89 mm Hg and ≥140/90 mm Hg, respectively). Despite the high prevalence of hypertension in young adults and its association with CVD, there is little evidence to guide BP screening and treatment recommendations in young adults. For BP screening, >25% of young adults in the US with hypertension are unaware that they have it. Moreover, social determinants of health (SDOH), an important influence on the health of young adults, is not considered in BP screening recommendations. For BP management, the benefits of initiating antihypertensive medications during young adulthood are unknown and are extrapolated from data among older adults. Due to the lack of evidence, most of the 13 million young adults with stage 1 hypertension are currently not recommended to initiate antihypertensive medication, and 50% (2.5 million) of young adults with stage 2 hypertension are currently left untreated. Although randomized controlled trials (RCTs) with hard CVD outcomes will provide definitive evidence, it may not be feasible to perform such a trial in young adults due to high costs and long follow-up time needed to determine CVD risk reduction benefits. In the absence of RCTs, high quality observational and simulation studies can provide clinically relevant and actionable evidence for policy makers, patients, and clinicians in a cost-efficient manner. The overall study objectives are to determine the optimal BP screening intervals for young adults and to identify those with a high risk of premature and/or lifetime CVD who may benefit from antihypertensive medication during young adulthood. The aims of this study are to (1) determine BP screening intervals by examining the timing of transitioning from normal BP into stage 1 or 2 hypertension and long-term BP trajectories, (2) identify characteristics of young adults with stage 1 or 2 hypertension who are at high risk for adverse CVD or renal outcomes, (3) quantify the benefits and harms of antihypertensive medication among young adults with stage 1 or 2 hypertension by emulating a hypothetical RCT using a large observational database and state-of-the-art statistical models to minimize confounding and selection bias, and (4) compare the short- and long-term health and economic impact of BP screening and management strategies for US young adults identified in Aims 1 to 3 vs. current BP guidelines. To address these aims, we will study ~500,000 young adults aged 18-39 years from both Kaiser Permanente Southern California and four epidemiologic cohorts. Findings from this study will inform future BP guidelines, reduce health inequity by directing screening and treatment to high risk subgroups, and improve cardiovascular health of US young adults.

项目摘要 过去几十年来，心血管疾病（CVD）的总体降低尚未 扩展到18-39岁的年轻人。年轻人中CVD风险因素的患病率越来越高， 包括高血压（BP），可能导致CVD率的提高。我们大约有20％的年轻人 成年人患有1或2期高血压（BP 130-139/80-89 mm Hg和≥140/90 mm Hg）。尽管 年轻人高血压及其与CVD的关联的高度患病率很少，几乎没有证据表明 指导年轻人的BP筛查和治疗建议。对于BP筛查，> 25％的年轻人 在美国，患有高血压并不意识到他们拥有它。此外，健康的社会决定者（SDOH）， 在BP筛选建议中未考虑对年轻人健康的重要影响。对于BP 管理，在成年时期启动降压药的好处是未知的， 从老年人的数据中推断出来。由于缺乏证据，1300万年轻人中的大多数 目前不建议使用第1期高血压来启动降压药，50％（2.5 目前，有2阶段高血压的年轻人中有百万）未经治疗。虽然被随机控制 具有硬性CVD结果的试验（RCT）将提供明确的证据，进行此类执行可能是不可行的 由于成本高昂和确定CVD风险降低所需的较长随访时间，年轻人的试验 好处。在没有RCT的情况下，高质量的观察和模拟研究可以在临床上提供 具有成本效益的政策制定者，患者和临床医生的相关证据。 总体研究目标是确定年轻人的最佳BP筛查间隔，并确定 那些可能会从降压药中受益的过早和/或终身CVD风险高的人 在成年期间。这项研究的目的是（1）通过检查BP筛选间隔 从正常BP过渡到第1阶段或2期高血压和长期BP轨迹的时机，（2）确定 患有不良CVD或肾脏高风险的年轻人的年轻人的特征 结果，（3）量化具有第1阶段的年轻人的降压药的益处和危害 或使用大型观察数据库和最先进的假设RCT通过模拟假设的RCT进行2高血压 统计模型以最大程度地减少混杂和选择偏见，（4）比较短期和长期健康 BP筛选和管理策略对我们在目标1中确定的年轻人的经济影响 3与当前的BP指南。为了解决这些目标，我们将研究约500,000年的18-39岁年轻人 来自Kaiser Permanente南加州和四个流行病学队列。这项研究的发现将 告知未来的BP指南，通过指导筛查和治疗来减少健康不平等 亚组，并改善美国年轻人的心血管健康。