Improving the Detection of Hypertension and its Control
改善高血压的检测及其控制
基本信息
- 批准号:10345380
- 负责人:
- 金额:$ 213.92万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AdultAgeAlbuminsAmbulatory Blood Pressure MonitoringAntihypertensive AgentsAsianBlack raceBlood PressureBlood Pressure MonitorsCardiovascular DiseasesCreatinineDataDetectionDevicesDiagnosisDiastolic blood pressureEchocardiographyElderlyEnrollmentEthnic OriginGuidelinesHealthHispanicHomeHome Blood Pressure MonitoringHourHypertensionIndividualLeft Ventricular MassLos AngelesMeasurementMeasuresMedicalMethodsMinorityMonitorNew YorkNot Hispanic or LatinoOffice VisitsOrganOutcomeParticipantPharmaceutical PreparationsPublic HealthRaceRandomizedReadingRecommendationReference StandardsReportingReproducibilityResearch DesignRisk FactorsSamplingSiteSubgroupTestingVisitWomanage differenceage groupawakebaseblood pressure controldisability-adjusted life yearshypertension controlhypertensiveimprovedindexingmodifiable riskprimary outcomescreeningsecondary outcomesexurinaryyears of life lostyoung adult
项目摘要
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和办公室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。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Paul Muntner其他文献
Paul Muntner的其他文献
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{{ truncateString('Paul Muntner', 18)}}的其他基金
Improving the Detection of Masked Hypertension: Analysis of Pooled Population- and Community-Based Studies
改善隐匿性高血压的检测:基于人群和社区的汇总研究分析
- 批准号:
10295572 - 财政年份:2020
- 资助金额:
$ 213.92万 - 项目类别:
UAB Cardiovascular Disease Predoctoral Training Program in Biostatistics and Epidemiology
UAB心血管疾病生物统计学和流行病学博士前培训项目
- 批准号:
10308453 - 财政年份:2020
- 资助金额:
$ 213.92万 - 项目类别:
UAB Cardiovascular Disease Predoctoral Training Program in Biostatistics and Epidemiology
UAB心血管疾病生物统计学和流行病学博士前培训项目
- 批准号:
10088039 - 财政年份:2020
- 资助金额:
$ 213.92万 - 项目类别:
Home blood pressure and falls among older adults
老年人的家庭血压和跌倒情况
- 批准号:
9769333 - 财政年份:2019
- 资助金额:
$ 213.92万 - 项目类别:
Home blood pressure and falls among older adults
老年人的家庭血压和跌倒情况
- 批准号:
10163695 - 财政年份:2019
- 资助金额:
$ 213.92万 - 项目类别:
Home blood pressure and falls among older adults
老年人的家庭血压和跌倒情况
- 批准号:
9976594 - 财政年份:2019
- 资助金额:
$ 213.92万 - 项目类别:
UAB Institutional Career Development Program in HIV-Related Heart, Lung, Blood and Research
UAB 艾滋病毒相关心脏、肺、血液和研究机构职业发展计划
- 批准号:
10216327 - 财政年份:2018
- 资助金额:
$ 213.92万 - 项目类别:
UAB Institutional Career Development Program in HIV-Related Heart, Lung, Blood and Research
UAB 艾滋病毒相关心脏、肺、血液和研究机构职业发展计划
- 批准号:
9753364 - 财政年份:2018
- 资助金额:
$ 213.92万 - 项目类别:
Evaluating novel approaches for estimating awake and sleep blood pressure
评估估计清醒和睡眠血压的新方法
- 批准号:
10026029 - 财政年份:2018
- 资助金额:
$ 213.92万 - 项目类别:
Incorporation of a Hypertension Working Group into the Jackson Heart Study
将高血压工作组纳入杰克逊心脏研究
- 批准号:
10398937 - 财政年份:2013
- 资助金额:
$ 213.92万 - 项目类别:
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