Clinical Implications of Blood Pressure Patterns Among Older Adults

老年人血压模式的临床意义

• 批准号: 10474978
• 负责人: STEPHEN P JURASCHEK
• 金额: $ 72.53万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10474978
• 关键词: Address; Adoption; Adult; Adverse event; Affect; Age; Age-Years; Aged, 80 and over; Aging; Ambulatory Blood Pressure Monitoring; American; Antihypertensive Agents; Atherosclerosis Risk in Communities; Biological Markers; Blood Pressure; Blood Screening; Brain natriuretic peptide; Cardiac; Cardiovascular Diseases; Cardiovascular system; Clinic; Clinical; Collaborations; Communities; Congestive Heart Failure; Coronary heart disease; Dementia; Diagnosis; Disease Pathway; Elderly; Equilibrium; Event; Funding; Gait; Gait speed; Goals; Guidelines; Heart Injuries; Home; Hospitalization; Hour; Hypertension; Hypotension; Hypotensives; Impaired cognition; Injury; Intervention Trial; Investments; Israel; Knowledge; Measurement; Measures; Medical center; Mentored Patient-Oriented Research Career Development Award; N-terminal; National Heart, Lung, and Blood Institute; Natriuretic Peptides; Neurocognitive; Orthostatic Hypotension; Participant; Pathway interactions; Pattern; Phenotype; Physical Function; Physical Performance; Physical assessment; Population; Population Heterogeneity; Prevalence; Prospective Studies; Protocols documentation; Reaction Time; Recommendation; Recurrence; Research; Research Personnel; Role; Specimen; Stroke; Supination; Time; Troponin T; United States; Visit; Visuospatial; Vulnerable Populations; Work; aging population; awake; base; blood pressure control; blood pressure intervention; blood pressure reduction; cardiovascular risk factor; cognitive function; cohort; fall risk; falls; follow-up; healthy aging; heart damage; hypertension treatment; middle age; modifiable risk; overtreatment; prevent; processing speed; treatment strategy

Hypertension affects nearly 100% of adults over 75 years of age, and the recent Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that targeting lower clinic-based blood pressure (BP) measurements prevented cardiovascular disease (CVD) events in older adults. However, hypotension-related hospitalizations were among the most significant complications from intensive BP treatment, despite SPRINT's carefully executed BP measurement protocols. The inability of clinic-based BP to predict hypotensive complications has led many to question whether lower BP treatment goals based on clinic BP alone are safe in older adults, who are especially vulnerable to perceived consequences of hypotension, like falls and dementia. While guidelines recommend that BP treatment be informed by standing clinic-based BP measurements and 24-hour ambulatory blood pressure monitoring (ABPM) outside of clinic, the prevalence and long-term implications of (1) low BP upon standing (i.e. orthostatic hypotension [OH]) and (2) large discrepancies between clinic and home BP (“white coat effects” [WCE]) are under-characterized among older adults. In this study, we apply our unique expertise with OH assessments and 24-hour ambulatory blood pressure monitoring (ABPM) to one of the most long-standing and well-respected American cohorts of community-dwelling adults, the Atherosclerosis Risk in Communities Study (ARIC). Our proposal will assess OH and ABPM in 2,345 black and white adults over age 80 years, establishing possibly the largest prospective study of both OH and WCE among older adults in the United States. Our aims are to quantify the prevalence of OH and WCE in this diverse population and determine the association of OH and WCE with longitudinal change in (1) physical function (balance, gait speed, gait pattern), (2) cognitive function (response time, visuospatial domains), and (3) highly sensitive markers of subclinical cardiac injury and strain, high sensitivity cardiac troponin T and N terminal b-type pro natriuretic peptide. Moreover, we will establish the association of OH and WCE with clinical events related to hypotension – falls, dementia, and CVD – over nearly four years of follow-up. Finding that OH and WCE in older adults are not associated with falls, dementia, and CVD would challenge current recommendations to screen for these BP patterns prior to BP treatment initiation or intensification, mitigating delays to treatment. However, finding that OH and WCE are prevalent and associated with falls, dementia, and CVD through our comprehensive measurement protocols would inform best practices for these assessments prior to treatment initiation and intensification to avoid adverse events among vulnerable adults. This proposal will inform guidelines for BP management by filling critical gaps in knowledge related to two BP patterns that are often cited as reasons to defer intensive therapy in older adults. Ultimately, our proposal directly answers the call by NHLBI's 2017 expert panel on BP measurement for high impact research that determines: (1) “the value of using orthostatic hypotension” and (2) “the role of ABPM…[in the] treatment of hypertension.”

高血压影响75岁以上的成年人的近100％，最近的系统血压 Intervatution试验（Sprint）表明，针对较低诊所的血压（BP）进餐 但是，在老年人中预防了心血管疾病（CVD）事件 尽管Sprint谨慎 执行的BP测量方案。 导致许多人质疑仅基于诊所BP的BP治疗目标较低 尤其容易受到明智的意识，例如秋天和痴呆症 建议通过基于诊所的BP测量和24小时的卧床来告知BP治疗 诊所外的血压监测（ABPM），（1）低BP的患病率和长期影响 站立（即正常屈服[OH]）和（2）诊所和家庭BP之间的巨大差异（“白色） 外套效应“ [WCE]）在老年人中的表征不足。 在这项研究中，我们将独特的专业知识应用于OH评估和24小时的卧床血压 监视（ABPM），是最长期和备受尊敬的美国居民之一 成人，社区研究中的动荡风险（ARIC）。 黑白白色成年人超过80岁，确立了OH和OH和 在美国的老年人中，我们的目标是量化这一点 多样化的人群并确定OH的关联，并与（1）物理的纵向变化与纵向变化 功能（平衡，步态速度，步态模式），（2）认知函数（2）和（3） 亚临床心脏损伤和应变的高度敏感标记，高灵敏性心脏肌钙蛋白T和N末端 b型尿素肽。此外，我们将建立OH的关联 与下降趋势，痴呆症和CVD相关的随访近四年。 发现老年人的OH和WCE与跌倒，痴呆和CVD无关 当前的建议在BP治疗开始或加强之前筛选这些BP模式。 但是，减轻治疗的延迟。 通过我们的全面测量协议，痴呆症和CVD将为这些提供最佳实践 在治疗启动和加强之前进行评估，以避免弱势成年人之间的不利事件。 该提案将通过填补与两个BP相关的知识的关键空白来为BP管理指南提供信息 通常被认为是在老年人中推迟密集的原因的模式。 回答NHLBI的2017年专家小组的BP测量专家小组的呼吁，以确定高影响力Resilech： （1）“使用体位压压的价值”和（2）“ ABPM的作用……在高血压治疗中。”