Epidemiology and pathophysiology of elevated nighttime blood pressure in CKD

CKD 夜间血压升高的流行病学和病理生理学

• 批准号: 8065537
• 负责人: Paul Englund Drawz
• 金额: $ 16.65万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8065537
• 关键词: Age; Ambulatory Blood Pressure Monitoring; Ancillary Study; Black race; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Characteristics; Chronic Kidney Failure; Chronic Kidney Insufficiency; Clinic; Clinical; Clinical Research; Clinical Trials; Cohort Studies; Cross-Sectional Studies; Data; Dedications; Development; Diabetes Mellitus; Disease; Electrocardiogram; Enrollment; Epidemiology; Etiology; Evaluation; Event; Faculty; Foundations; Functional disorder; Future; General Population; Glomerular Filtration Rate; Goals; Home Blood Pressure Monitoring; Hypertension; Incidence; Investigation; K-Series Research Career Programs; Kidney Diseases; Laboratories; Lead; Left Ventricular Mass; Linear Regressions; Logistic Regressions; Longitudinal Studies; Measures; Mediating; Medical History; Medicine; Mentors; Methods; Morbidity - disease rate; Organ; Outcome; Patients; Population; Posture; Prevalence; Principal Investigator; Proteinuria; Reading; Renal function; Research; Research Personnel; Risk Factors; Sodium; Stroke; Structure; Study Subject; Time; Training; Uric Acid; Urine; Work; autonomic neuropathy; base; cardiovascular disorder risk; career; career development; clinical epidemiology; clinical practice; cohort; experience; high risk; improved; indexing; insight; interest; masked hypertension; member; mortality; multidisciplinary; public health relevance; research and development; research study; standard of care; statistics; symposium; white coat hypertension; Age; Ambulatory Blood Pressure Monitoring; Ancillary Study; Black race; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Characteristics; Chronic Kidney Failure; Chronic Kidney Insufficiency; Clinic; Clinical; Clinical Research; Clinical Trials; Cohort Studies; Cross-Sectional Studies; Data; Dedications; Development; Diabetes Mellitus; Disease; Electrocardiogram; Enrollment; Epidemiology; Etiology; Evaluation; Event; Faculty; Foundations; Functional disorder; Future; General Population; Glomerular Filtration Rate; Goals; Home Blood Pressure Monitoring; Hypertension; Incidence; Investigation; K-Series Research Career Programs; Kidney Diseases; Laboratories; Lead; Left Ventricular Mass; Linear Regressions; Logistic Regressions; Longitudinal Studies; Measures; Mediating; Medical History; Medicine; Mentors; Methods; Morbidity - disease rate; Organ; Outcome; Patients; Population; Posture; Prevalence; Principal Investigator; Proteinuria; Reading; Renal function; Research; Research Personnel; Risk Factors; Sodium; Stroke; Structure; Study Subject; Time; Training; Uric Acid; Urine; Work; autonomic neuropathy; base; cardiovascular disorder risk; career; career development; clinical epidemiology; clinical practice; cohort; experience; high risk; improved; indexing; insight; interest; masked hypertension; member; mortality; multidisciplinary; public health relevance; research and development; research study; standard of care; statistics; symposium; white coat hypertension

DESCRIPTION (provided by applicant): The overall aims of this five-year Career Development Award are to: 1) enable the candidate's career development as an independent clinical researcher through advanced didactic coursework, structured mentoring, and conduct/analysis of a clinical research study; and 2) better understand the epidemiology and pathophysiology of ambulatory blood pressure (BP), specifically elevated nighttime BP, in subjects with chronic kidney disease (CKD). Hypertension is highly prevalent and is a major risk factor for cardiovascular disease, kidney disease, and death. BP is traditionally measured in the clinic, but there is increasing interest in ambulatory BP monitoring. The best ambulatory BP predictor appears to be nighttime BP. CKD has been shown to be a risk factor for elevated nighttime BP. Cardiac autonomic neuropathy is associated with elevated nighttime BP in patients with and without CKD. The relationship between CKD, cardiac autonomic neuropathy, and elevated nighttime BP is not well studied. The candidate will conduct a cross-sectional and longitudinal study of ambulatory BP in subjects enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, and collect additional data as part of the approved Epidemiology and Pathophysiology of Elevated Nighttime Blood Pressure in CKD Ancillary Study. The specific aims of the candidate's proposed study are: 1) determine the prevalence of masked hypertension, white-coat hypertension, and true hypertension in patients with CKD; 2) evaluate the clinical characteristics, including cardiac autonomic neuropathy, associated with elevated nighttime BP in patients with CKD; and 3) evaluate the clinical characteristics associated with a change in nighttime BP over time in patients with CKD. Data will include detailed medical history, laboratory evaluation, electrocardiograms, comprehensive cardiovascular evaluation, and ascertainment of clinical outcomes. Statistical analysis will include multiple linear and logistic regressions. The candidate will be mentored by a multidisciplinary team led by Dr Mahboob Rahman, a principal investigator in CRIC and an experienced researcher with expertise in hypertension and CKD. The candidate has shown a dedication to a career in research through work as a Clinical Research Scholar and will enhance this research experience and formal training by taking advanced coursework in statistics and epidemiology. In addition to the advanced didactic coursework and mentored research experience, the candidate will participate in research and career development seminars and conferences as a faculty member in the Department of Medicine and the Center for Clinical Investigation. This Career Development Award will provide the foundation for the candidate to pursue an independent research career dedicated to better understanding the pathophysiology of and reducing the subsequent morbidity and mortality associated with chronic kidney disease and hypertension. PUBLIC HEALTH RELEVANCE: High blood pressure is common and is a major risk factor for cardiovascular disease, kidney disease, and death. Nighttime blood pressure may be the best predictor for adverse clinical events but is not well sudied. A better understanding of the mechanisms that lead to elevated nighttime BP will provide insight for future clinical trials that specifically target elevated nighttime BP with the goal of reducing morbidity and mortality.

描述（由申请人提供）：这项五年职业发展奖的总体目标是：1）通过先进的教学课程，结构化指导以及对临床研究研究的实现/分析，使候选人成为独立的临床研究人员的职业发展； 2）更好地了解慢性肾脏疾病（CKD）的卧床血压（BP）的流行病学和病理生理（BP），特别是夜间BP。高血压高度普遍，是心血管疾病，肾脏疾病和死亡的主要危险因素。 BP传统上是在诊所中测量的，但对卧床BP监测的兴趣越来越高。最好的门诊BP预测因子似乎是夜间BP。 CKD已被证明是夜间BP升高的危险因素。心脏自主神经病变与患有和没有CKD的患者的夜间BP升高有关。 CKD，心脏自主神经病和升高的夜间BP之间的关系尚未得到很好的研究。该候选人将对慢性肾功能不全队列（CRIC）研究的受试者进行门诊BP的横截面和纵向研究，并作为CKD辅助研究中认可的流行病学和病理生理学的一部分收集其他数据。候选人提出的研究的具体目的是：1）确定CKD患者的蒙面高血压，白涂层高血压和真实高血压的患病率； 2）评估临床特征，包括与CKD患者夜间BP升高有关的心脏自主神经病； 3）评估CKD患者的夜间BP随时间变化相关的临床特征。数据将包括详细的病史，实验室评估，心电图，全面的心血管评估以及临床结果的确定。统计分析将包括多个线性和逻辑回归。候选人将由由CRIC的首席研究员Mahboob Rahman博士领导的多学科团队，并且具有高血压和CKD专业知识的经验丰富的研究人员。候选人通过作为临床研究学者的工作表现出对研究事业的奉献精神，并将通过统计和流行病学领域的高级课程来增强这一研究经验和正式培训。除了先进的教学课程和指导研究经验外，候选人还将参加医学系和临床研究中心的研究和职业发展研讨会和会议。该职业发展奖将为候选人提供独立研究职业的基础，致力于更好地理解与慢性肾脏疾病和高血压相关的随后的发病率和死亡率的病理生理学。 公共卫生相关性：高血压很常见，是心血管疾病，肾脏疾病和死亡的主要危险因素。夜间血压可能是不良临床事件的最佳预测因子，但没有很好地预测。更好地了解导致夜间BP升高的机制，将为以后的临床试验提供洞察力，该试验专门针对夜间BP，目的是降低发病率和死亡率。