Determining true versus apparent treatment-resistant hypertension among African Americans in the Jackson Heart Study

杰克逊心脏研究中确定非裔美国人真实与明显的难治性高血压

• 批准号: 10491097
• 负责人: Rikki M Tanner
• 金额: $ 67.69万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10491097
• 关键词: Adherence; Adult; Adverse event; African American; African American population; Ambulatory Blood Pressure Monitoring; American Heart Association; Ancillary Study; Antihypertensive Agents; Award; Blood Pressure; Chronic Kidney Failure; Clinic; Clinic Visits; Clinical; Coronary heart disease; Data; Data Collection; Diabetes Mellitus; Diagnosis; Enrollment; Evaluation; Funding; Future; Grant; Health; Healthcare; Heavy Drinking; High Prevalence; Hyperaldosteronism; Hypertension; Individual; Infrastructure; Intake; Jackson Heart Study; Kidney; Kidney Diseases; Knowledge; Lead; Measurement; Monitor; Non-Steroidal Anti-Inflammatory Agents; Obesity; Obstructive Sleep Apnea; Organ; Outcome; Parents; Participant; Patient Recruitments; Patients; Pattern; Persons; Pharmaceutical Preparations; Phenotype; Population; Prevalence; Prognosis; Prospective cohort; Prospective cohort study; Race; Regimen; Research Personnel; Resistant Hypertension; Resources; Respiration Disorders; Risk; Risk Factors; Role; Secondary to; Sleep; Sodium; Translations; Urinalysis; Visit; base; blood pressure control; blood pressure elevation; cardiovascular disorder risk; clinical diagnosis; clinical translation; comparison group; diagnostic algorithm; diet and exercise; high risk; lifestyle factors; medication compliance; mortality; overtreatment; physical inactivity; racial disparity; recruit; research clinical testing; screening; unhealthy lifestyle

Abstract African Americans (AAs) have a high prevalence of hypertension and suffer a disproportionately high risk for cardiovascular disease compared to whites. Apparent treatment-resistant hypertension (aTRH) is a severe form of hypertension defined as requiring ≥ 4 antihypertensive medications to achieve blood pressure (BP) control. An estimated 9 million US adults have aTRH. Given the rigorous clinical work-up needed to rule out pseudoresistance and therefore, diagnose true TRH, the population prevalence of TRH is not known. We propose an ancillary study to the Jackson Heart Study (JHS), a large prospective cohort of AA adults (n=5,306) that will deeply phenotype participants with aTRH, ruling out pseudoresistance (i.e., inaccurate clinic BP measurement, presence of a white coat effect, suboptimal antihypertensive therapy, and poor medication adherence) and secondary causes of hypertension (i.e., primary aldosteronism, obstructive sleep apnea, and kidney disease). The JHS provides a highly feasible setting for the proposed study as it includes a large population of AAs with a high prevalence of hypertension and extensive data collection as part of an upcoming fourth parent study visit, which will facilitate the screening and recruitment of participants for our ancillary study. Based on data collected during the fourth JHS exam, we will identify 400 participants with aTRH and 200 treatment-responsive controls. These participants will undergo a clinical evaluation for TRH including assessment of existing ambulatory BP monitoring (ABPM) data to detect white coat effect and urinalysis of antihypertensive drugs and metabolites to assess medication adherence. Also, participants with aTRH will be compared to treatment responsive controls with respect to secondary causes of hypertension and lifestyle factors. Clinical translation of the study findings will be facilitated by an external panel of experts who co-authored the American Heart Association 2018 Scientific Statement on Resistant Hypertension. Overall, the diagnosis and treatment of TRH is limited by our understanding of pseudoresistance and other factors underlying aTRH. The proposed study is urgently needed to more efficiently diagnose and better treat this severe form of hypertension among African Americans.

抽象的 非洲裔美国人（AAS）的高血压患病率很高，遭受不成比例的 与白人相比，心血管疾病的高风险。明显的耐药性 高血压（ATRH）是一种严重的高血压形式，定义为需要≥4抗高血压 获得血压（BP）控制的药物。估计有900万美国成年人 Atrh。考虑到排除伪造症所需的严格临床检查，因此 诊断为TRUE TRH，TRH的人口流行率尚不清楚。我们提出了一个辅助 研究杰克逊心脏研究（JHS）的研究，这是一个大量的AA成年人（n = 5,306）的研究 将与ATRH深入表型参与者，排除伪耐药性（即不准确的诊所 BP测量，存在白色外套效应，次优抗高血压疗法和 药物依从性不佳）和高血压的继发原因（即原发性醛固酮主义， 阻塞性睡眠呼吸暂停和肾脏疾病）。 JHS为 拟议的研究包括大量的AA，高患病率 高血压和广泛的数据收集，作为即将到来的第四次父母研究访问的一部分， 这将促进参与者进行辅助研究的筛查和招聘。基于 关于在第四次JHS考试期间收集的数据，我们将确定400名具有ATRH的参与者 200个治疗响应对照。这些参与者将对TRH进行临床评估 包括评估现有的门诊BP监控（ABPM）数据以检测白色外套 降压药和代谢产物的作用和尿液分析，以评估药物依从性。 此外，将ATRH的参与者与有关治疗响应对照的对照 高血压和生活方式因素的次要原因。研究结果的临床翻译 将由共同撰稿的外部专家组成的专家组成 协会2018耐药性高血压的科学陈述。总体而言，诊断和 TRH的治疗受到我们对伪造和其他因素的理解的限制 基础ATRH。迫切需要拟议的研究以更有效地诊断和 更好地治疗非裔美国人中这种严重的高血压形式。