Improving the Detection of Hypertension and its Control

改善高血压的检测及其控制

• 批准号: 10345380
• 负责人: Paul Muntner
• 金额: $ 213.92万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10345380
• 关键词: Adult; Age; Albumins; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Asian; Black race; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Creatinine; Data; Detection; Devices; Diagnosis; Diastolic blood pressure; Echocardiography; Elderly; Enrollment; Ethnic Origin; Guidelines; Health; Hispanic; Home; Home Blood Pressure Monitoring; Hour; Hypertension; Individual; Left Ventricular Mass; Los Angeles; Measurement; Measures; Medical; Methods; Minority; Monitor; New York; Not Hispanic or Latino; Office Visits; Organ; Outcome; Participant; Pharmaceutical Preparations; Public Health; Race; Randomized; Reading; Recommendation; Reference Standards; Reporting; Reproducibility; Research Design; Risk Factors; Sampling; Site; Subgroup; Testing; Visit; Woman; age difference; age group; awake; base; blood pressure control; disability-adjusted life years; hypertension control; hypertensive; improved; indexing; modifiable risk; primary outcome; screening; secondary outcome; sex; urinary; years of life lost; young adult

Blood pressure (BP) measured in the office is used to diagnose hypertension and guide BP management for adults taking antihypertensive medication. Guidelines recommend measuring BP outside of the office using ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) to confirm office BP, averaged across multiple visits. The evidence supporting this recommendation is weak since most prior studies compared BP on ABPM or HBPM against office BP measured at a single visit. Guidelines also recommend that ABPM be performed over a 24-hour period and HBPM be based on 2 measurements in the morning (AM) and 2 measurements in the evening (PM) for 7 days. Many guidelines endorse ABPM as the reference standard for out-of-office BP monitoring, but there are few data comparing ABPM to HBPM conducted for 7 days. We recently completed a study of 400 adults that compared BP measured during 3 office visits, on ABPM, and HBPM, each conducted following guideline-recommended approaches. The study found (1) BP on HBPM was associated with left ventricular mass index (LVMI), a marker of target end-organ damage, independent of office BP and BP on ABPM, (2) office BP and BP on ABPM were not associated with LVMI, independent of BP on HBPM, (3) HBPM was more reliable (i.e. reproducible) than ABPM and office BP, and (4) office BP was more reliable than ABPM. These results suggest a new paradigm that HBPM is superior to ABPM and office BP, and ABPM is not needed when office BP and HBPM are both performed. However, no one in this study was taking antihypertensive medication, few older adults were enrolled, and a minority had high office BP. These findings need to be tested in a larger study with broader generalizability. We propose to enroll 1,696 adults in New York, NY, Birmingham, AL, and Los Angeles, CA with screening systolic/diastolic BP <160/100 mm Hg; 50% of whom will be taking antihypertensive medication. The sample will be diverse based on age (33% in each age group: 18-39, 40-59, and ≥60 years), sex (50% women), race/ethnicity (≥25% non-Hispanic white, ≥25% non-Hispanic Black, ≥25% Hispanic, and ≥10% Asian), and office BP level (50% with office BP ≥130/80 mm Hg). Office BP will be measured at 3 visits. ABPM will be performed over two 24-hour periods and HBPM will be performed with 2 AM and 2 PM measurements per day over two 7-day periods. Two markers of target end-organ damage – LVMI on echocardiogram and albumin-to-creatinine ratio – will be assessed. We will determine whether BP on HBPM is more strongly associated with target end-organ damage than office BP and awake BP on ABPM (Primary Aim 1). We will determine if HBPM is more reliable than office BP and awake BP on ABPM (Primary Aim 2). We will also determine whether the findings are consistent using asleep BP and 24-hour BP instead of awake BP, and investigate potential differences among age, sex, and race/ethnicity subgroups (Secondary Aims). The study will determine the best approach to measure BP for diagnosing and managing hypertension, which has the potential to improve the health of millions of US adults.

在办公室中测量的血压（BP）用于诊断高血压和指导BP管理 成人服用降压药。指南建议使用办公室外测量BP 卧床BP监控（ABPM）或家庭BP监控（HBPM）确认办公室BP，平均 多次访问。支持该建议的证据很弱，因为大多数先前的研究比较了BP 在一次访问时测量的ABPM或HBPM上针对办公室BP。指南还建议ABPM 在24小时内进行，HBPM基于早晨的2个测量值（AM）和2个测量值 晚上（PM）的测量7天。许多准则认可ABPM作为参考标准 彻底的BP监测，但是很少有数据比较ABPM与HBPM进行了7天。我们 最近完成了一项研究400名成年人的研究，该研究比较了在3次办公室访问，ABPM和 hbpm，每种都按照指南推荐的方法进行。该研究发现（1）hbpm上的bp是 与左心室质量指数（LVMI）相关，该指数是目标端管损伤的标记，独立于办公室 ABPM上的BP和BP，（2）ABPM上的办公室BP和BP与LVMI无关，与BP无关 HBPM，（3）HBPM比ABPM和Office BP更可靠（即可重现），并且（4）办公室BP更多 比ABPM可靠。这些结果表明，HBPM优于ABPM和办公室的新范式 当执行办公室BP和HBPM时，BP和ABPM不需要ABPM。但是，没有人 研究正在服用降压药，很少有老年人入学，少数人的职务高 bp。这些发现需要在一项更广泛的概括性研究中进行测试。我们建议注册1,696 纽约，纽约，伯明翰，阿拉巴马州和加利福尼亚州洛杉矶的成年人，筛查收缩/舒张BP <160/100 MM HG;其中50％将服用降压药。样本将根据年龄为潜水员 （每个年龄段的33％：18-39、40-59和≥60岁），性别（50％女性），种族/民族（≥25％非西班牙裔 白色，≥25％的非西班牙裔黑人，≥25％西班牙裔和≥10％的亚洲人）和办公室BP水平（50％的办公室BP ≥130/80 mm Hg）。办公室BP将以3次访问进行测量。 ABPM将在两个24小时内进行，并且 HBPM将在两个7天的时间内以每天2点和下午2点的测量进行。两个标记 将评估目标最终器官损伤 - 超声心动图和相册比率的LVMI - 将评估。我们 将确定HBPM上的BP是否与目标最终器官损坏更密切相比 并在ABPM上清醒BP（主要目标1）。我们将确定HBPM是否比办公室BP更可靠 在ABPM上唤醒BP（主要目标2）。我们还将确定在使用睡眠的发现是否一致 BP和24小时的BP代替醒着的BP，调查年龄，性别和性别之间的潜在差异 种族/民族亚组（次要目的）。该研究将确定测量BP的最佳方法 诊断和管理高血压，这有可能改善美国数百万美国成年人的健康。