Blood Pressure in Dialysis Patients

透析患者的血压

• 批准号: 8303440
• 负责人: DANA C MISKULIN
• 金额: $ 50.23万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8303440
• 关键词: Academic Medical Centers; Acute myocardial infarction; Adherence; Adverse event; Blood Pressure; Blood Vessels; Cardiovascular Diseases; Cardiovascular system; Case Mixes; Cerebrum; Chronic Kidney Failure; Clinic; Clinical; Congestive Heart Failure; Coronary; Data Coordinating Center; Dialysis patients; Dialysis procedure; Disadvantaged; Disease Outcome; Dropout; Drops; End stage renal failure; Event; Foundations; France; Funding; General Population; Goals; Guidelines; Health; Health Sciences; Heart Diseases; Hemodialysis; Home environment; Homeostasis; Hospitalization; Hospitals; Hypertension; Intervention; Kidney; Kidney Diseases; Left Ventricular Mass; London; Magnetic Resonance Imaging; Measurement; Measures; Medical; Medical center; Meta-Analysis; Minority; Monitor; Morbidity - disease rate; New Mexico; Non-Insulin-Dependent Diabetes Mellitus; Observational Study; Outcome; Patients; Perfusion; Physiologic pulse; Pilot Projects; Population; Principal Investigator; Publishing; Randomized; Randomized Controlled Trials; Reading; Recruitment Activity; Reporting; Research; Research Personnel; Safety; Schedule; Serious Adverse Event; South Carolina; Specific qualifier value; Stroke; Thrombosis; Training; United States National Institutes of Health; Universities; Woman; arm; cardiovascular disorder risk; cardiovascular risk factor; cohort; design; health related quality of life; hypertension control; improved; indexing; meetings; mortality; primary outcome; programs; public health relevance; secondary outcome; trial comparing; two-arm study

DESCRIPTION (provided by applicant): Hypertension is a major cause of cardiovascular (CV) morbidity and mortality. Although studies in the general population have demonstrated a continuous reduction in CV risk with each mmHg drop in systolic blood pressure (SBP), multiple observational studies conducted in hemodialysis (HD) patients have demonstrated that patients with mild to moderate hypertension may have decreased mortality compared to those with normal BP. We recently reported that among HD patients, those with routine pre-dialysis BP values that met the KDOQI guidelines (<140/90 mm Hg) had increased mortality compared to patients with mild to moderate hypertension. However, these observational studies included untreated patients in whom low or normal BP may reflect significant cardiac disease or other comorbid conditions. In the setting of reduced vascular compliance and impaired autoregulation, aggressive BP lowering may decrease coronary or cerebral perfusion. Thus, it is unclear if aggressive BP lowering will be harmful or beneficial. A well-designed RCT is needed to answer this important question. Prior to conducting a full-scale RCT it is prudent to conduct a pilot study to assess feasibility and inform the design of the former. We propose to conduct a pilot RCT in a prevalent cohort of HD patients treated in facilities operated by Dialysis Clinics Inc. (DCI). To accomplish this goal we assembled an outstanding team including investigators affiliated with academic medical centers including the University of New Mexico, (Zager, Bedrick, Servilla), Tufts (Miskulin, Levey), and Medical University of South Carolina (Ploth, Budisavljevic). Dr. London (H"pital Lariboisi¿re) will provide expertise in assessing aortic stiffness. Brigham and Women's Hospital (Kwong) will serve as the MRI reading center. The Cleveland Clinic Foundation (Gassman) will serve as the Data Coordinating Center. Drs. Zager, Miskulin and Ploth will be the Principal Investigators. PUBLIC HEALTH RELEVANCE: (1) It is feasible to conduct a RCT in which HD patients are randomized to a standardized pre-dialysis systolic blood pressure (SBP) of <140 mmHg or <160 mmHg. (2) There we will be a significant difference in the changes in left ventricular mass index (LVMI), assessed by magnetic resonance imaging between the two BP arms.

描述（由适用提供）：高血压是心血管（CV）发病率和死亡率的主要原因。尽管对普通人群的研究表明，每种MMHG收缩压（SBP）的CV风险持续降低，但在血液透析（HD）患者中进行的多项观察性研究表明，与正常BP相比，患有轻度至中度高血压的患者可能会降低死亡率。我们最近报告说，与患有轻度至中度高血压的患者相比，在HD患者中，符合KDOQI指南（<140/90 mm HG）的常规前BP值（<140/90 mm HG）的死亡率增加。但是，这些观察性研究包括未经治疗的患者，其中低或正常的BP可能反映了严重的心脏病或其他合并症。在减少血管依从性和自动调节受损的情况下，侵袭性的BP降低可能会降低冠状动脉或脑灌注。这是目前尚不清楚降低积极的BP是否有害或有益。需要精心设计的RCT来回答这个重要问题。在进行全尺度RCT之前，谨慎进行试点研究以评估可行性并告知前者的设计。我们建议在透析诊所公司（DCI）经营的设施中进行的普遍存在的HD患者中进行试验RCT。为了实现这一目标，我们组建了一支杰出的团队，其中包括与新墨西哥大学（Zager，Bedrick，Servilla），Tufts（Miskulin，Levey）和南卡罗来纳州医科大学（Ploth，Budisavljevic）等学术医学中心的分支机构。伦敦博士（H“ Pital Lariboisi re）将在评估主动脉僵硬方面提供专业知识。Brighamand妇女医院（Kwong）将担任MRI阅读中心。克利夫兰诊所基金会（Gassman）将作为数据协调中心。 公共卫生相关性：（1）可行进行RCT，其中HD患者被随机分配为<140 mmHg或<160 mmHg的标准化前透析前收缩压（SBP）。 （2）在那里，通过两个BP臂之间的磁共振成像评估，左心室质量指数（LVMI）的变化将有显着差异。

项目成果

Design of the Blood Pressure Goals in Dialysis pilot study.

• DOI: 10.1097/maj.0b013e31827daee5
• 发表时间: 2014-02
• 期刊: The American journal of the medical sciences
• 作者: Gul A;Miskulin D;Gassman J;Harford A;Horowitz B;Chen J;Paine S;Bedrick E;Kusek JW;Unruh M;Zager P;BID Pilot Study Investigators
• 通讯作者: BID Pilot Study Investigators