A New Paradigm for Hypertension in the Elderly- Beyond Age

老年人高血压的新范式——超越年龄

• 批准号: 8756375
• 负责人: Michelle Christina Odden
• 金额: $ 31.43万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2018-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8756375
• 关键词: Adult; Adverse event; Age; Aging; Aging-Related Process; Area; Blood Pressure; Body Composition; Cardiovascular system; Cessation of life; Cognitive; Complex; Data; Diastolic blood pressure; Elderly; Event; Funding; Future; Generations; Goals; Health; Health Status; Heterogeneity; Hypertension; Hypotension; Individual; Latino; Life; Machine Learning; Measures; Meta-Analysis; Methods; National Health and Nutrition Examination Survey; Observational Study; Outcome; Participant; Persons; Physiological; Population; Psyche structure; Randomized Controlled Trials; Reporting; Research; Risk; Risk Factors; Role; Secondary Prevention; Stroke; Subgroup; Testing; United States National Institutes of Health; Walkers; Walking; Work; adverse outcome; base; clinical practice; cohort; design; evidence base; functional status; high risk; improved; meetings; middle age; mortality; novel; systolic hypertension; treatment effect

DESCRIPTION (provided by applicant): Over 60% of adults age ≥ 65 years have high blood pressure (BP), but optimal management of high BP in the elderly remains controversial. Contrary to evidence in middle age that lowering BP is clearly beneficial, data in older adults are inconsistent and high BP may not be a risk factor in all elders. We recently reported that, among participants in the National Health and Nutrition Examination Survey age e65 years, high BP was a risk factor for all-cause and cardiovascular (CV) death only among persons in better health status (defined as fast walking of a 20-ft walk test). In contrast, high BP was not a risk factor among slow walkers. Additionally, the benefit of lowering BP in all elders remains an issue of debate; a recent meta-analysis in persons age 80 years and older reported no benefit of BP treatment on mortality, and significant heterogeneity across trials. Finally, there is growin concern for potential harms associated with treatment to lower BP. Excessive lowering of BP, particularly diastolic, has been associated with increased risk for death and cardiovascular events in some studies. In the proposed research, we propose a novel paradigm where the associations of BP with adverse outcomes in older persons are considered in the setting of the complex aging process. Our long-term goal is to reliably identify elderly persons in whom BP treatment is beneficial and those in whom treatment is ineffective or even harmful, by defining subpopulations of similar health status. Specifically, aim 1 proposes to elucidate factors from four domains (functional, cognitive/mental, self-rated health, and physiologic) that can identify elderly persons in whom high systolic BP is strongly associated with higher risk for death and CV events, and those in whom it is not, using data from three NIH-funded cohorts: Cardiovascular Health Study (CHS), Health Aging and Body Composition (Health ABC) and Sacramento Area Latino Study of Aging (SALSA). In aim 2, we will evaluate the role of diastolic BP across level of health status. Finally, based on findings from these observational cohorts, in aim 3 we will evaluate whether these factors can identify elderly persons in whom treatment to lower BP is of maximum benefit in two randomized controlled trials: the Systolic Hypertension in the Elderly (SHEP) and the Secondary Prevention of Small Subcortical Strokes (SPS3). Since participants in trials are healthier than the U.S. population, we will also evaluate the effect of treatment in the observational studies, using state-of-the-art causal inference methods, which can correct for the bias of standard analytic approaches. Completion of these aims will substantially advance our understanding of the importance of high BP in older adults; will improve our ability to identify elderly persons who will benefit from BP treatment; will allow a systematic understanding of groups in whom evidence for BP treatment is lacking; and will guide design of future trials of hypertension in elderly adults.

描述（由适用提供）：超过60％的成年人≥65岁的血压高（BP），但对古老的BP的最佳管理仍然存在争议。与中年降低BP显然是有益的证据相反，老年人的数据是不一致的，而高BP可能并不是所有年龄段的危险因素。我们最近报告说，在国家健康和营养检查调查的参与者中，E65岁时，高bp是全因和心血管（CV）死亡的危险因素，仅在健康状况更好的人中（定义为20英尺步行测试的快速步行）。相比之下，高bp不是慢步行者的危险因素。此外，在所有长者中降低BP的好处仍然是辩论的问题。最近在80岁及以上的人中进行的一项荟萃​​分析报告了BP治疗对死亡率没有好处，并且在试验中没有明显的异质性。最后，人们越来越关注与降低BP相关的潜在危害。在某些研究中，过度降低BP，特别是舒张压，与死亡和心血管事件的风险增加有关。在拟议的研究中，我们提出了一种新颖的范式，在复杂的衰老过程的情况下，考虑了BP与老年人的不良结果的关联。我们的长期目标是可靠地确定BP治疗是有益的老年人，以及那些通过定义相似健康状况的亚群来确定治疗方法无效甚至有害的老年人。具体而言，目的是1个建议，以阐明四个领域（功能，认知/心理，自我评价健康和生理学）的因素，这些因素可以识别出老年人，其中高收缩压BP与死亡和CV事件的较高风险密切相关，并且使用三个NIH资助的同胞（健康阶层）（既定健康的人）（CHSIBCAIL SARTC）（CHSIBCAIL SARTC）（CHSIS）的数据（CHS），并不是较高的死亡风险和CV事件的较高风险（CHS），且既不是健康的（CHS），并且拉丁裔衰老研究（莎莎）。在AIM 2中，我们将评估舒张压在健康状况范围内的作用。最后，根据这些观察群体的发现，在AIM 3中，我们将评估这些因素是否可以识别为降低BP治疗的老年人在两项随机对照试验中具有最大的益处：老年人（SHEP）的收缩压（SHEP）和小皮质下雷（SPSS3）的次要预防（SPS3）。由于试验的参与者比美国人群更健康，因此我们还将使用最新的因果推理方法评估观察性研究中治疗的影响，这可以纠正标准分析方法的偏见。这些目标的完成将大大促进我们对高BP在老年人中的重要性的理解。将提高我们确定将从BP治疗中受益的老年人的能力；将允许对缺乏BP治疗证据的群体进行系统的了解；并将指导老年人未来高血压试验的设计。