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: 10166673
• 负责人: Emily B Levitan
• 金额: $ 87.26万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 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 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10166673
• 关键词: Adopted; Adult; Advisory Committees; Affect; Agreement; Albumins; Albuminuria; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Blood Pressure; Canada; Clinic; Contusions; Creatinine; Data; Data Analyses; Devices; Diagnosis; Diastolic blood pressure; Enrollment; Equipoise; Expert Opinion; Goals; Guidelines; Health Personnel; Health behavior; Home; Home Blood Pressure Monitoring; Hour; Hypertension; Intervention Trial; Lead; Left Ventricular Mass; Level of Evidence; Measurement; Measures; Mercury; Methods; Monitor; New York; Organ; Pain; Participant; Patients; Personal Communication; Persons; Pharmaceutical Preparations; Phenotype; Prevalence; Preventive service; Procedures; Psychosocial Factor; Public Health; Recommendation; Reference Standards; Research Design; Risk; Sleep; Sphygmomanometers; Testing; Time; Visit; accurate diagnosis; awake; blood pressure intervention; blood pressure reduction; cardiovascular disorder risk; clinical practice; diagnosis standard; indexing; masked hypertension; monitoring device; novel; novel strategies; screening; urinary; white coat hypertension

In the US, hypertension is diagnosed by measuring blood pressure (BP) in the clinic by a healthcare provider or technician (attended clinic BP). However, this approach provides a poor estimate of a person's BP. Ambulatory BP monitoring (ABPM) measures BP automatically every 15 to 30 minutes outside of the clinic setting typically for 24 hours including while a person is awake and asleep. Although ABPM is considered to be the reference standard for diagnosing hypertension, it is not available in most clinics in the US and, when available, it is not tolerated by many patients. These issues highlight the need for new approaches for diagnosing hypertension. Canadian studies suggest that BP measured in the clinic using an automatic oscillometric device without an observer being present (unattended clinic BP) may be closer to awake BP on ABPM than attended clinic BP. However, these studies were uncontrolled with unattended clinic BP being measured after attended clinic BP; attended clinic BP was performed using a mercury sphygmomanometer, which is no longer the recommended for measuring BP; and often participants with very high attended clinic BP were enrolled. A recent analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT) did not find a difference between clinic BP when measured attended or unattended. However, participants did not have both attended and unattended BP measured at the same visit; all participants were taking antihypertensive medication; and data from ABPM were not available as a reference standard. In addition to elevated awake BP, elevated BP during sleep is associated with an increased risk of CVD. ABPM has been the only method that could measure sleep BP. A home BP monitoring (HBPM) device has recently been developed that can measure BP during sleep. In contrast to ABPM, these HBPM devices are worn for a shorter period of time (only during sleep) with fewer BP measurements, and thus may be better tolerated than ABPM. The goal of this study is to compare novel non-ABPM approaches to ABPM for measuring BP during the awake and sleep periods and diagnosing hypertension. For Aim 1, we will test whether unattended clinic BP provides a more accurate estimate of awake BP on ABPM than attended clinic BP. For Aim 2, we will determine the accuracy of a new HBPM device for measuring sleep BP. We will also evaluate whether the HBPM device is better tolerated than ABPM. For Aim 3, we will compare the associations of unattended clinic BP and attended clinic BP versus awake BP on ABPM and sleep BP on HBPM versus ABPM with left ventricular mass index and albuminuria. We will enroll 630 adults, not taking antihypertensive medication, with systolic BP of 110 to 159 mm Hg and diastolic BP of 70 to 99 mm Hg in New York, NY and Birmingham, AL. Participants will undergo both unattended and attended clinic BP, in random order, and ABPM and HBPM, also in random order. This rigorously designed study will provide important data on whether these new approaches can replace the need for conducting ABPM to assess awake and sleep BP and diagnose hypertension.

在美国，高血压是通过医疗保健提供者在诊所测量血压 (BP) 来诊断的 或技术员（到诊所 BP）。然而，这种方法对一个人的血压的估计很差。 动态血压监测 (ABPM) 在诊所外每 15 至 30 分钟自动测量一次血压 通常设置为 24 小时，包括人醒着和睡着时。尽管 ABPM 被认为是 诊断高血压的参考标准，在美国大多数诊所都没有， 可用，但许多患者不能耐受。这些问题凸显了采取新方法的必要性 诊断高血压。加拿大研究表明，在诊所使用自动血压计测量血压 没有观察者在场的示波装置（无人值守的诊所血压）可能更接近清醒时的血压 ABPM 比就诊的血压要高。然而，这些研究不受控制，无人值守的诊所血压被 就诊后测量血压；使用水银血压计对就诊诊所进行血压测量， 不再推荐用于测量血压；并且通常参加诊所的人数非常多 BP 已入组。最近对收缩压干预试验 (SPRINT) 数据的分析表明 在有人或无人值守的情况下测量诊所血压时，没有发现差异。然而，参与者并没有 在同一次就诊中测量了有人参与和无人参与的血压；所有参与者都采取 抗高血压药物； ABPM 数据无法作为参考标准。此外 清醒时血压升高、睡眠时血压升高与心血管疾病风险增加相关。 ABPM 已 唯一可以测量睡眠血压的方法。最近，家庭血压监测（HBPM）设备 开发出可以在睡眠期间测量血压的技术。与 ABPM 相比，这些 HBPM 设备的佩戴时间较短 血压测量值较少的一段时间（仅在睡眠期间），因此可能比 ABPM 具有更好的耐受性。 本研究的目的是比较新颖的非 ABPM 方法与 ABPM 测量血压的方法 清醒和睡眠时期以及诊断高血压。对于目标1，我们将测试是否无人值守 诊所血压可以比就诊诊所血压更准确地估计 ABPM 上的清醒血压。对于目标 2，我们将 确定用于测量睡眠血压的新型 HBPM 设备的准确性。我们还将评估是否 HBPM 设备比 ABPM 具有更好的耐受性。对于目标 3，我们将比较无人值守诊所的关联 血压和就诊血压与 ABPM 的清醒血压和 HBPM 的睡眠血压与左侧 ABPM 的比较 心室质量指数和蛋白尿。我们将招募 630 名未服用抗高血压药物的成年人， 纽约州纽约市和阿拉巴马州伯明翰市的收缩压为 110 至 159 毫米汞柱，舒张压为 70 至 99 毫米汞柱。 参与者将按随机顺序接受无人值守和有人值守的诊所血压、动态血压监测 (ABPM) 和血压监测 (HBPM) 以随机顺序。这项严格设计的研究将提供重要数据，说明这些新方法是否 可以取代进行 ABPM 来评估清醒和睡眠血压并诊断高血压的需要。

项目成果

Impact of Asleep and 24-Hour Blood Pressure Data on the Prevalence of Masked Hypertension by Race/Ethnicity.

睡眠和 24 小时血压数据对不同种族/民族的隐匿性高血压患病率的影响。

• 发表时间: 2022-07-01
• 影响因子: 3.2
• 作者: Yano, Yuichiro;Poudel, Bharat;Chen, Ligong;Sakhuja, Swati;Jaeger, Byron C;Viera, Anthony J;Shimbo, Daichi;Clark, Donald;Anstey, David Edmund;Lin, Feng;Lewis, Cora E;Shikany, James M;Rana, Jamal S;Correa, Adolfo;Lloyd;S
• 通讯作者: S

A Tale of 2 Blood Pressures.

两种血压的故事。

• 发表时间: 2020
• 影响因子: 39
• 作者: Dodson, John A;Shimbo, Daichi
• 通讯作者: Shimbo, Daichi

Does This Adult Patient Have Hypertension?: The Rational Clinical Examination Systematic Review.

这位成年患者是否患有高血压？：合理的临床检查系统评价。

• DOI: 10.1001/jama.2021.4533
• 发表时间: 2021-07-27
• 期刊: JAMA
• 作者: A. Viera;Y. Yano;F. Lin;D. Simel;Jonathan D. Y. Yun;Gaurav Dave;A. Von Holle;L. Viera;D. Shimbo
• 通讯作者: D. Shimbo

Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018.

1999-2000 年至 2017-2018 年美国成人高血压患者血压控制趋势。

• DOI: 10.1001/jama.2020.14545
• 发表时间: 2020-09-09
• 期刊: JAMA
• 作者: P. Muntner;Shakia T. Hardy;Lawrence J. Fine;Byron C. Jaeger;G. Wozniak;E. Levitan;Lis;ro D. Colantonio;ro
• 通讯作者: ro

Racial and Ethnic Differences in Blood Pressure Among US Adults, 1999-2018.

1999-2018 年美国成年人血压的种族和民族差异。

• 发表时间: 2021-12
• 作者: Hardy, Shakia T;Chen, Ligong;Cherrington, Andrea L;Moise, Nathalie;Jaeger, Byron C;Foti, Kathryn;Sakhuja, Swati;Wozniak, Gregory;Abdalla, Marwah;Muntner, Paul
• 通讯作者: Muntner, Paul