Advancing Personalized Hypertension Care through Big Data Science

通过大数据科学推进个性化高血压护理

• 批准号: 10439511
• 负责人: Steven Michael Smith
• 金额: $ 13.6万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10439511
• 关键词: Accounting; Achievement; Adoption; Adverse event; Affect; American; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Biometry; Blood Pressure; Caring; Cessation of life; Characteristics; Chronic; Chronic Disease; Clinical; Clinical Data; Cohort Studies; Data; Data Set; Development; Diuretics; Drug Prescriptions; Drug Side Effects; Drug Utilization; Effectiveness; Electronic Health Record; Ensure; Environment; Florida; Foundations; Funding; Future; Goals; Health; Health system; Heterogeneity; Hypertension; Individual; Infrastructure; Knowledge; Lead; Leadership; Measurement; Measures; Mentors; Mentorship; Methods; Modeling; National Heart, Lung, and Blood Institute; Observation in research; Observational Study; Outcome; Patient-Focused Outcomes; Patients; Pattern; Personal Satisfaction; Pharmaceutical Preparations; Pharmacoepidemiology; Pharmacotherapy; Pharmacy facility; Population; Public Health; Recommendation; Research; Research Design; Research Methodology; Research Personnel; Resources; Risk; Risk Factors; Safety; Scientist; Selection for Treatments; Standardization; Statistical Models; Testing; Thiazide Diuretics; Training; Trust; Uncertainty; Universities; Validation; Variant; Work; base; big-data science; biomedical informatics; blood pressure control; care outcomes; career development; clinical data repository; clinical decision support; clinically actionable; clinically relevant; design; experience; hypertension control; hypertension treatment; improved; individual patient; individual response; multidisciplinary; multilevel analysis; optimal treatments; patient response; personalized approach; personalized care; population health; predicting response; predictive modeling; programs; repository; response; routine practice; skills; sound; support tools; treatment effect; treatment response; unnecessary treatment

PROJECT SUMMARY. The current hypertension (HTN) treatment paradigm of trial-and-error drug selection has remained essentially unchanged for nearly half a century. Personalizing care has been challenging because patients and clinicians too often lack adequate evidence to inform individual care decisions. But, broad electronic health record (EHR) adoption has created opportunities for using routinely-collected clinical data to inform evidence. Applying principles of causal inference, such data can be used to identify clinical factors that influence observed variation in treatment response and, in turn, incorporate these factors into statistical models for predicting future treatment response for individuals. The unifying theme of this NHLBI K01 proposal is the mentored career development of Dr. Steven M. Smith. This proposal will accelerate his transition to an independent researcher and establish the foundation for achieving his long-term goal of using routinely-collected clinical data to substantially improve the health and wellbeing of patients by personalizing care. Dr. Smith's objective with this project is to better understand real world use of antihypertensive drugs and factors that influence response to such drugs, with the goal of creating prediction models for use in clinical decision support tools to make personalized HTN management recommendations. The specific research aims include characterizing real world antihypertensive drug prescribing patterns and their determinants (Aim 1), identifying treatment effect modifiers for both effectiveness and safety of two common antihypertensive classes, angiotensin-converting enzyme inhibitors (ACE-Is) and thiazide diuretics (Aim 2) and, developing models for predicting response to ACE-Is and thiazide diuretics to maximize antihypertensive efficacy (Aim 3). This work will leverage observational research methodologies with the OneFlorida Data Trust, a statewide repository of longitudinal EHR data on >8 million Floridians. Dr. Smith's training and experience in clinical pharmacy, public/population health, and HTN care ensure the clinical relevance of the project. His previous clinical HTN research experience and background in applied biostatistics, combined with the proposed training incorporating biomedical informatics, pharmacoepidemiology, multilevel modeling, and leadership, ensure the feasibility of this proposed work and his further development. University of Florida resources and infrastructure, including the UF CTSI, the Biomedical Informatics Program, and the OneFlorida Research Consortium, provide an ideal environment for achieving the proposed objectives and Dr. Smith's long-term goals. Dr. Rhonda Cooper-DeHoff will lead a multidisciplinary mentorship team composed of experts in pharmacoepidemiology (Dr. Almut Winterstein), biostatistics (Dr. Matthew Gurka), biomedical informatics (Dr. Bill Hogan), clinical HTN (Dr. Carl Pepine), and leadership (Dr. Anne Libby). The integrated mentored research experience and training will allow Dr. Smith to compete for R01 funding and become an independent clinician-scientist using observational research methods with large-scale EHR data to improve drug therapy selection for individuals.

项目摘要。反复试验药物的当前高血压（HTN）治疗范例 将近半个世纪的时间基本上保持不变。个性化护理一直具有挑战性 因为患者和临床医生经常缺乏足够的证据来为个人护理决定提供信息。但， 广泛的电子健康记录（EHR）采用为使用常规收集的临床创造了机会 数据提供证据。应用因果推断的原则，可以使用此类数据来识别临床 影响治疗反应变化的因素，然后将这些因素纳入 预测个人未来治疗反应的统计模型。这个NHLBI K01的统一主题 提案是史蒂文·史密斯（Steven M. Smith）博士的指导职业发展。该提议将加速他的 过渡到独立研究人员，并为实现其长期目标的基础建立了基础 常规收集的临床数据可通过个性化实质上改善患者的健康和福祉 关心。史密斯博士对这个项目的目标是更好地了解对降压药的现实世界使用 影响对此类药物反应的因素，目的是创建用于临床使用的预测模型 决策支持工具，以提出个性化的HTN管理建议。具体研究目的 包括表征现实世界的降压药处方模式及其决定因素（AIM 1）， 识别两种常见抗高血压的有效性和安全性的治疗效果修饰符 类，血管紧张素转换酶抑制剂（ACE-IS）和噻嗪类利尿剂（AIM 2），以及发展 预测对Ace-IS和噻嗪类利尿剂的反应以最大化降压功效的模型（AIM 3）。 这项工作将通过Oneflorida Data Trust（全州）利用观察性研究方法来利用观测研究方法。 纵向EHR数据的存储库> 800万佛罗里达人。史密斯博士的临床培训和经验 药房，公共/人口健康和HTN护理确保该项目的临床相关性。他的前任 临床HTN研究经验和应用生物统计学的背景，并结合拟议的培训 纳入生物医学信息学，药物电子学，多层次建模和领导才能确保 这项提议的工作及其进一步发展的可行性。佛罗里达大学资源与基础设施， 包括UF CTSI，生物医学信息学计划和Oneflorida研究联盟，提供 实现拟议目标和史密斯博士的长期目标的理想环境。 Rhonda博士 Cooper-Dehoff将领导一个由药物ePidemiology专家组成的多学科指导团队 （Almut Winterstein博士），生物统计学（Matthew Gurka博士），生物医学信息学（Bill Hogan博士），临床HTN （Carl Pepine博士）和领导力（Anne Libby博士）。综合的指导研究经验和培训 将允许史密斯博士竞争R01资金，并使用 具有大规模EHR数据的观察性研究方法可改善对个体的药物治疗选择。

项目成果

Racial and ethnic differences in blood pressure before and after the 2016 United States general election.

2016 年美国大选前后种族和民族血压差异。

• DOI: 10.1002/ajhb.23785
• 发表时间: 2022
• 期刊: American journal of human biology : the official journal of the Human Biology Council
• 作者: Hwang,AndrewY;Cardel,MichelleI;Smith,StevenM
• 通讯作者: Smith,StevenM

Medication Adherence-Still the Holy Grail.

• DOI: 10.1161/jaha.122.028688
• 发表时间: 2023-02-21
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Cooper-DeHoff, Rhonda M. M.;Smith, Steven M. M.
• 通讯作者: Smith, Steven M. M.

Use of Prescription Medications That Potentially Interfere With Blood Pressure Control in New-Onset Hypertension and Treatment-Resistant Hypertension.

在新发高血压和难治性高血压中使用可能干扰血压控制的处方药。

• DOI: 10.1093/ajh/hpy118
• 发表时间: 2018
• 期刊: American journal of hypertension
• 影响因子: 3.2
• 作者: Hwang,AndrewY;Dave,ChintanV;Smith,StevenM
• 通讯作者: Smith,StevenM

Initial Antihypertensive Prescribing in Relation to Blood Pressure Among Florida Medicaid and Medicare Recipients in the OneFlorida+ Research Consortium.

OneFlorida 研究联盟的佛罗里达州医疗补助和医疗保险接受者中与血压相关的初始抗高血压处方。

• DOI: 10.1161/hypertensionaha.123.21901
• 发表时间: 2024
• 期刊: Hypertension (Dallas, Tex. : 1979)
• 作者: Smith,KaylaM;Keshwani,Shailina;Walsh,MartaG;Winterstein,AlmutG;Gurka,MatthewJ;Libby,Anne;Hogan,WilliamR;Pepine,CarlJ;Cooper-DeHoff,RhondaM;Smith,StevenM
• 通讯作者: Smith,StevenM

Thiazide Exposure and Cardiovascular Risk in Type 2 Diabetes Mellitus: A Point of Clarification.

2 型糖尿病患者的噻嗪类药物暴露与心血管风险：需要澄清的一点。

• DOI: 10.1161/hypertensionaha.119.14447
• 发表时间: 2020
• 期刊: Hypertension (Dallas, Tex. : 1979)
• 作者: Smith,StevenM;Winterstein,AlmutG;Pepine,CarlJ;Cooper-DeHoff,RhondaM
• 通讯作者: Cooper-DeHoff,RhondaM