Chronic Lower Leg Heating for the Treatment of Hypertension in Older Women

慢性小腿加热治疗老年女性高血压

基本信息

批准号：
10552697
负责人：
QI FU
金额：
$ 55.19万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-03-01 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10552697
关键词：
Adherence Adjuvant Antihypertensive Agents Bathing Biological Availability Blood Pressure Blood Vessels Blood Volume Blood flow Body Temperature Cardiovascular Diseases Cardiovascular system Cause of Death Chlorthalidone Chronic Combined Modality Therapy Control Groups Cutaneous Data Diastolic blood pressure Diuretics Doppler Ultrasound Dose Effectiveness Ensure Equipment Exposure to Frequencies Guidelines Health Heat Stress Disorders Heating Home Hour Human Human Resources Hypertension Immersion Individual Knee Laboratories Leg Limb structure Microdialysis Modality Morbidity - disease rate Muscle Nitrates Nitric Oxide Nitrites Oral Outcome Patients Personal Satisfaction Pharmaceutical Preparations Pharmacological Treatment Pharmacotherapy Prevalence Protocols documentation Public Health Randomized Recommendation Regimen Research Research Project Grants Resistance Risk Risk Reduction Sauna Skin Standardization Techniques Temperature Testing Therapeutic Therapeutic heat application Tissues Training Trees United States Vascular resistance Vasoconstrictor Agents Vasodilator Agents Water Woman blood pressure control blood pressure medication blood pressure reduction blood pressure regulation cardiovascular risk factor clinical practice compliance behavior drug standard effective therapy evidence base group intervention hypertension control hypertension treatment hypertensive improved indexing insight interstitial mortality neural neuroregulation older men older women participant enrollment patient population patient safety pressure response shear stress tonometry treatment strategy vascular bed vasoconstriction

项目摘要

PROJECT SUMMARY The prevalence of hypertension is greater in older (≥65 years) women than in older men, while the blood pressure (BP) control rate is lower in older women in the United States. Uncontrolled hypertension is a major risk factor for cardiovascular morbidity and mortality. Despite standard therapy and adherence to optimal drug regimens, over 50% of older hypertensive women still have inadequate BP control (e.g. >140/90 mmHg), and the control rate is further reduced with more aggressive BP targets recommended recently by the new 2017 ACC/AHA Hypertension Guidelines. Thus, the effectiveness of drug treatment alone in the control of hypertension among older women is limited; hence, non-pharmacological approaches are also needed to help reduce BP and cardiovascular morbidity and mortality in older hypertensive women. One adjuvant, non- pharmacological approach that offers promise in lowering BP is “heat therapy”. Indeed, repeated (chronic) whole-body heat exposure has been found to decrease BP in healthy humans. Whether this is also true after regional limb heating in hypertensive patients is unknown. The global objectives of this research project are to investigate the BP lowering effect of home-based lower leg heat therapy in older women with hypertension, and to examine the impact of this therapeutic modality on neural-vascular health in these patients. Specific Aim 1 will test the hypothesis that chronic lower leg heat therapy combined with an antihypertensive drug is superior to drug treatment alone in lowering BP in older hypertensive women. We will randomly assign older hypertensive women to either an intervention group or a control group. Patients in the intervention group will perform 8 weeks of home-based lower leg heat therapy via water immersion up to the knee in a circulated bath (water temperature 42°C, 4 times per week, 45 min per session), whereas patients in the control group will immerse their legs in a thermoneutral water bath (33°C) at the same frequency and duration. All patients will also receive a fixed dose of chlorthalidone (a diuretic, 25 mg orally once daily). We will compare ambulatory BP, the BP control rate, and patient adherence and acceptability to treatment between the groups. Specific Aim 2 will test the hypothesis that chronic lower leg heat therapy will improve nitric oxide bioavailability which can decrease sympathetic vasoconstriction and improve vascular function in older hypertensive women. We will use state-of-the-art techniques of microneurography, Doppler ultrasound, applanation tonometry, and cutaneous microdialysis to assess sympathetic neural control, indices of conduit and resistance vessel vasodilator function, and interstitial metabolites (i.e. nitrate and nitrite) indicative of basal nitric oxide bioavailability in all patients enrolled in Aim 1 before and after 8 weeks of heat therapy. Information obtained from this research project will guide evidence-based clinical practice. It is anticipated that our study may lead to revision of hypertension guidelines to incorporate home-based heat therapy as adjuvant to antihypertensive drug(s) for older women, as well as other patient populations.

项目摘要在年龄较大（≥65岁）的女性中，高血压的患病率高于年龄较大的男性，而血液美国老年妇女的压力（BP）控制率较低。不受控制的高血压是主要的心血管发病率和死亡率的危险因素。尽管标准疗法并遵守最佳药物超过50％的老年高血压女性的治疗疗法仍然不足以控制（例如> 140/90 mmHg），并且新2017年推荐的更具侵略性的BP目标进一步降低了控制率 ACC/AHA高血压指南。那，仅药物治疗在控制中的有效性老年妇女的高血压是有限的。因此，还需要非药理学方法来帮助老年高血压女性的BP和心血管发病率和死亡率。一个调整，非 - 在降低BP方面提供希望的药理方法是“热疗法”。确实，重复（慢性）已经发现全身热量暴露会降低健康人的BP。这是否也是真的高血压患者的区域肢体加热尚不清楚。该研究项目的全球目标正在调查家庭基于家庭的下腿热疗法对年龄较大女性的BP降低作用高血压，并检查这种治疗方式对神经血管健康的影响这些患者。具体目标1将检验以下假设：慢性下腿热疗法与降压药在降低老年高血压女性的BP中仅优于药物治疗。我们将将老年高血压女性随机分配给干预组或对照组。患者干预组将通过浸入水到达8周的家庭下腿热治疗膝盖在圆形浴中（水温为42°C，每周4次，每次45分钟），而患者则对照组将以相同的频率和期间。所有患者还将接受固定剂量的氯噻酮（每天口服25毫克的利尿剂）。我们将比较门诊BP，BP控制率以及患者的依从性和可接受性两组之间。特定的目标2将检验慢性下腿热疗法将改善的假设一氧化氮生物利用度可以减少交感神经收缩并改善血管功能年长的高血压女性。我们将使用微功能学的最新技术，多普勒超声，施用量计和皮肤微透析以评估交感神经控制，导管指数以及抗性血管舒张函数，以及指示碱性的基本代谢物（即硝酸盐和亚硝酸盐）在热疗法8周之前和之后，所有患者的一氧化氮生物利用度均在AIM 1中。信息从该研究项目获得的将指导基于证据的临床实践。预计我们的研究可能会导致修订高血压指南，以纳入家庭热疗法以适应老年妇女以及其他患者人群的降压药。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Acute lower leg hot water immersion protects macrovascular dilator function following ischaemia-reperfusion injury in humans.

急性小腿热水浸泡可保护人类缺血再灌注损伤后的大血管扩张功能。

DOI：
10.1113/ep088154
发表时间：
2020
期刊：
Experimental physiology
影响因子：
2.7
作者：
Engelland,RachelE;Hemingway,HoldenW;Tomasco,OliviaG;Olivencia-Yurvati,AlbertH;Romero,StevenA
通讯作者：
Romero,StevenA

Acute heat exposure improves microvascular function in skeletal muscle of aged adults.

急性热暴露可改善老年人骨骼肌的微血管功能。

DOI：
10.1152/ajpheart.00645.2021
发表时间：
2022
期刊：
American journal of physiology. Heart and circulatory physiology
影响因子：
0
作者：
Richey,RauchelleE;Hemingway,HoldenW;Moore,AmyM;Olivencia-Yurvati,AlbertH;Romero,StevenA
通讯作者：
Romero,StevenA