Exercise as an adjunct therapy to reduce blood pressure in Chronic Kidney Disease

运动作为降低慢性肾脏病血压的辅助疗法

基本信息

批准号：
8425358
负责人：
Ulf G Bronas
金额：
$ 6.85万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-01 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8425358
关键词：
Aerobic Exercise Affect Angiotensins Bioavailable Biological Markers Blood Pressure Blood Vessels Cardiovascular Diseases Caring Chronic Kidney Failure Control Groups Data Diabetes Mellitus Drops Endothelin-1 Exercise Funding Future Goals Hour Hypertension Hypotension Individual Intervention Investigation Kidney Diseases Medical Nitric Oxide Nitric Oxide Synthase Outcome Participant Patients Peripheral Resistance Physical therapy exercises Physiological Pilot Projects Population Randomized Randomized Controlled Trials Relative (related person)Research Research Personnel Rest Staging Testing Therapeutic Therapeutic Intervention Training Vasoconstrictor Agents Work base blood pressure regulation clinical practice design diabetic dimethylarginine experience improved inhibitor/antagonist insight non-diabetic novel programs public health relevance response

项目摘要

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) affects more than 26 million individuals (13% of the U.S. population), and is projected to increase 70%, to over 40 million individuals by the year 2015. Inadequate blood pressure control is a major factor in the progression of CKD. Exercise is a potential adjunct therapy to reduce blood pressure in CKD patients. However, no large randomized, controlled trials specifically designed to investigate resting and 24-hr blood pressure levels in response to exercise training have been completed, and results of small, non- randomized studies have been mixed. The PI's (Dr. Bronas) current investigation (K23) on the cardioprotective effects of aerobic exercise in stage 2-4 diabetic CKD indicates significant exercise-induced reductions in mean resting blood pressure levels of 11.8 mm Hg systolic and 5.6 mm Hg diastolic (preliminary data, n=31). However, it is unknown if patients with non-diabetic CKD will experience a similar benefit. The proposed study will expand the scope of the PI's current research program and allow us to conduct the first randomized, controlled trial specifically designed to investigate the effect of regular aerobic exercise on resting and 24-hr blood pressure levels in patients with stage 3-4 CKD and hypertension. By expanding the scope of the current research we will be able to compare the blood-pressure reducing effect of exercise in the two major CKD populations that may benefit the most from exercise therapy. The objective of the proposed pilot study is therefore to test the hypothesis that regular aerobic exercise will lower resting and 24-hour ambulatory blood pressure levels in stage 3-4 non-diabetic CKD patients with hypertension. We will achieve this objective by randomizing 40 patients with stage 3-4 non-diabetic CKD with hypertension to either 12 weeks of aerobic exercise training (n=20) or usual medical care (n=20). In addition, we will determine the effect of 12 weeks of exercise training on effective vascular compliance and biomarkers associated with blood pressure regulation, and their association with exercise-induced changes in blood pressure levels. This study will generate new hypotheses regarding the impact of exercise therapy on factors associated with blood pressure regulation in patients with CKD-hypertension and provide insight into new and adjunctive treatment options. The expected outcomes of the work proposed is to further our understanding of the benefit of regular exercise on blood pressure control in patients with CKD and provide insight into the relative physiological responses to exercise in patients with non-diabetic CKD or diabetic CKD. Moreover, this study will directly enhance Dr. Bronas research capability as he is completing his transition to fully independent investigator status and allow him to quickly move into independent R01 funding.

描述（由申请人提供）：慢性肾病 (CKD) 影响着超过 2600 万人（占美国人口的 13%），预计到 2015 年将增加 70%，达到超过 4000 万人。血压控制不足是CKD进展的主要因素。运动是降低 CKD 患者血压的潜在辅助疗法。然而，尚未完成专门用于研究运动训练对静息血压和 24 小时血压水平的影响的大型随机对照试验，而且小型非随机研究的结果也参差不齐。 PI（Bronas 博士）目前对 2-4 期糖尿病 CKD 中有氧运动的心脏保护作用进行的调查 (K23) 表明，运动引起的平均静息血压水平显着降低，收缩压为 11.8 毫米汞柱，舒张压为 5.6 毫米汞柱（初步数据）数据，n=31）。然而，目前尚不清楚非糖尿病 CKD 患者是否会获得类似的益处。拟议的研究将扩大 PI 当前研究计划的范围，并使我们能够开展第一个随机对照试验，专门设计用于研究定期有氧运动对 3-4 期患者静息和 24 小时血压水平的影响CKD 和高血压。通过扩大当前研究的范围，我们将能够比较运动对可能从运动疗法中获益最多的两个主要 CKD 人群的降压效果。因此，拟议试点研究的目的是检验以下假设：定期有氧运动会降低患有高血压的 3-4 期非糖尿病 CKD 患者的静息血压和 24 小时动态血压水平。我们将通过将 40 名患有高血压的 3-4 期非糖尿病 CKD 患者随机分为 12 周的有氧运动训练 (n=20) 或常规医疗护理 (n=20) 来实现这一目标。此外，我们将确定 12 周的运动训练对有效血管顺应性和与血压调节相关的生物标志物的影响，以及它们与运动引起的血压水平变化的关系。这项研究将提出关于运动疗法对 CKD 高血压患者血压调节相关因素的影响的新假设，并为新的辅助治疗方案提供见解。这项工作的预期结果是进一步了解定期运动对 CKD 患者血压控制的益处，并深入了解非糖尿病 CKD 或糖尿病 CKD 患者对运动的相对生理反应。此外，这项研究将直接增强 Bronas 博士的研究能力，因为他即将完成向完全独立研究者身份的过渡，并使他能够快速获得独立的 R01 资助。