Psychosocial Factors and Aging: Resting/Reflexive Cardiovascular Control

心理社会因素和衰老：静息/反射性心血管控制

• 批准号: 8532602
• 负责人: Richard P SLOAN
• 金额: $ 21.99万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-15 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8532602
• 关键词: Affective; Age; Aging; Atherosclerosis; Autonomic nervous system; Baroreflex; Behavioral; Biological Markers; Blood Pressure; Cardiac; Cardiovascular system; Clinic; Clinical; Communities; Consensus; Data; Data Collection; Development; Diagnosis; Entropy; Frequencies; Health; Heart Rate; Heart failure; Hour; Hypertension; Inflammatory; Link; Measurement; Measures; Methods; Morbidity - disease rate; Myocardial Infarction; Noise; Organ; Participant; Patients; Periodicity; Physiological; Physiology; Positioning Attribute; Psychosocial Factor; Recovery; Research; Rest; Risk; Sampling; Series; Testing; Therapeutic Intervention; Time; Transplant Recipients; Variant; adverse outcome; autonomic reflex; base; cardiovascular risk factor; clinically significant; community health study; contextual factors; follow-up; heart rate variability; indexing; insight; middle age; mortality; novel; pressure; prognostic; prospective; psychologic; psychosocial; public health relevance; response; Affective; Age; Aging; Atherosclerosis; Autonomic nervous system; Baroreflex; Behavioral; Biological Markers; Blood Pressure; Cardiac; Cardiovascular system; Clinic; Clinical; Communities; Consensus; Data; Data Collection; Development; Diagnosis; Entropy; Frequencies; Health; Heart Rate; Heart failure; Hour; Hypertension; Inflammatory; Link; Measurement; Measures; Methods; Morbidity - disease rate; Myocardial Infarction; Noise; Organ; Participant; Patients; Periodicity; Physiological; Physiology; Positioning Attribute; Psychosocial Factor; Recovery; Research; Rest; Risk; Sampling; Series; Testing; Therapeutic Intervention; Time; Transplant Recipients; Variant; adverse outcome; autonomic reflex; base; cardiovascular risk factor; clinically significant; community health study; contextual factors; follow-up; heart rate variability; indexing; insight; middle age; mortality; novel; pressure; prognostic; prospective; psychologic; psychosocial; public health relevance; response

DESCRIPTION (provided by applicant): For decades, we have known that lower heart rate (HR) is associated with reduced morbidity and mortality. But HR is not stable - it is inherently "noisy," oscillating around the mean. Beginning in the 1980s, the clinical and physiological significance of these oscillations, now known as Heart Rate Variability (HRV), has been recognized. HRV predicts adverse outcomes following myocardial infarction or diagnosis of heart failure, progression of atherosclerosis in CAD patients, and the development of CAD in healthy community samples. Thus, measurement "noise" in HR is now recognized as a valuable index of cardiovascular health. Today, blood pressure (BP) is in a similar position as HR was 40 years ago. While the clinical significance of mean blood pressure (BP) has been accepted for decades, within-subject BP varies considerably across multiple time scales. Once dismissed as noise, BP variability (BPV) now also is thought to contain valuable information. Measured repeatedly over weeks or even years, the standard deviation (SD) of clinic-to-clinic BP predicted the development of hypertension and mortality after 12-14 years follow-up. On a 24-hour scale, the SD of BP measured every 30 min was associated with cardiovascular mortality after 8.5 years follow-up and with greater target organ damage. At a still shorter time scale, BP varies on a beat-to-beat basis. Consensus in the field is that the ultimate prognostic value of BPV may require analysis of these beat-to-beat BP oscillations. However, because measurement of these more rapid oscillations has been technically demanding, associations of beat-to-beat BPV with clinical or with psychosocial variables linked to health have not been established. Technological advances have made beat-to-beat BPV increasingly available and exploration of its relationship to cardiovascular health and contextual sociodemographic and psychosocial cardiovascular risk factors has the potential to yield important clinical and physiological insights. Measuring beat-to-beat BP along with RR intervals also allows for computation of baroreflex sensitivity (BRS), the relationship of reflexive changes in RR interval to changes in BP. While BPV may represent a tonic autonomic index, BRS is an index of autonomic reflexes that predicts adverse outcomes after MI and in heart failure. However, to our knowledge, community studies of BPV and BRS do not exist. We propose to analyze the beat-to-beat BP data already collected but not analyzed from participants at rest and in response to psychological and orthostatic challenge from the wave 2 of data collection in the Midlife in the US (MIDUS II) study. Our aims in this R21 are to examine relationships between resting and reactive BPV and BRS and psychosocial and biomarker data across the age spectrum and in an exploratory prospective analysis, to test whether greater BPV and lower BRS are associated with greater mortality.

描述（由申请人提供）：数十年来，我们知道较低的心率（HR）与发病率和死亡率降低有关。但是人力资源并不稳定 - 它本质上是“嘈杂的”，在均值周围振荡。从1980年代开始，已经认识到这些振荡（现在称为心率变异性（HRV））的临床和生理意义。 HRV预测心肌梗死或心力衰竭，CAD患者动脉粥样硬化的进展以及健康社区样本中CAD的发展后，会产生不良后果。因此，人力资源中的测量“噪声”现在被认为是心血管健康的宝贵指数。 如今，血压（BP）的位置与HR相似，HR 40年前。尽管平均血压（BP）的临床意义已被接受了数十年，但受试者内BP在多个时间尺度上差异很大。 BP变异性（BPV）曾经被视为噪声，现在也被认为包含有价值的信息。诊所到临床BP的标准偏差（SD）在数周甚至几年中反复衡量，预测了12 - 14年的随访后高血压和死亡率的发展。在24小时的标准下，每30分钟测量的BP的SD与经过8.5年的随访后的心血管死亡率相关，并且目标器官损坏更大。在较短的时间范围内，BP在Beat-Beat的基础上有所不同。该领域的共识是，BPV的最终预后价值可能需要分析这些BET到BP振荡。但是，由于对这些更迅速的振荡的测量在技术上是要求的，因此尚未建立BET-BEAT BPV与临床或与健康相关的社会心理变量的关联。技术进步使BPV越来越多地获得，并探索了其与心血管健康以及上下文社会人口统计学和心理心理心血管危险因素的关系，有可能产生重要的临床和生理见解。 测量Beat-to-Beat BP以及RR间隔还可以计算BaroreFlex灵敏度（BRS），RR间隔中反射性变化与BP变化的关系。虽然BPV可能代表了滋补自主指数，但BRS是自主反射的指数，可以预测MI后和心力衰竭后的不良结果。但是，据我们所知，对BPV和BRS的社区研究并不存在。 我们建议分析已经收集的BET到BP数据，但没有根据REST的参与者进行分析，并响应美国中年研究（Midus II）研究的数据收集2次数据收集的心理和体位挑战。我们在R21中的目标是检查整个年龄范围内的静止和反应性BPV与BRS以及心理社会和生物标志物数据之间的关系，以及在探索性的前瞻性分析中，以测试更大的BPV和下BR是否与更大的死亡率相关。