Blood Pressure Measurement and Hypertension in Pregnancy

妊娠期血压测量和高血压

• 批准号: 9898438
• 负责人: Natalie A Bello
• 金额: $ 19.24万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9898438
• 关键词: Abruptio Placentae; Address; Adherence; Adult; Affect; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Biometry; Blood Pressure; Blood pressure determination; Chronic; Clinic; Clinical; Complex; Data; Devices; Diagnosis; Diastolic blood pressure; Disease; Environment; Epidemiology; Fetal Growth Retardation; Fetus; Foundations; Future; Goals; Guidelines; Health Personnel; Home Blood Pressure Monitoring; Home environment; Hour; Hypertension; Individual; K-Series Research Career Programs; Knowledge; Maternal-fetal medicine; Measurement; Measures; Medical; Monitor; Morbidity - disease rate; Mothers; Outcome; Patients; Perfusion; Pharmaceutical Preparations; Placental Insufficiency; Population; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Public Health; Reading; Reporting; Research; Research Design; Research Personnel; Risk; Role; Second Pregnancy Trimester; Statistical Data Interpretation; Stroke; Training; Validation; Woman; base; career; career development; design; evidence base; fetal; hemodynamics; high risk; hypertension treatment; men; monitoring device; mortality; multidisciplinary; overtreatment; pregnancy disorder; pregnancy hypertension; pregnant; pressure; programs; research data dissemination; Abruptio Placentae; Address; Adherence; Adult; Affect; Ambulatory Blood Pressure Monitoring; Antihypertensive Agents; Biometry; Blood Pressure; Blood pressure determination; Chronic; Clinic; Clinical; Complex; Data; Devices; Diagnosis; Diastolic blood pressure; Disease; Environment; Epidemiology; Fetal Growth Retardation; Fetus; Foundations; Future; Goals; Guidelines; Health Personnel; Home Blood Pressure Monitoring; Home environment; Hour; Hypertension; Individual; K-Series Research Career Programs; Knowledge; Maternal-fetal medicine; Measurement; Measures; Medical; Monitor; Morbidity - disease rate; Mothers; Outcome; Patients; Perfusion; Pharmaceutical Preparations; Placental Insufficiency; Population; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Public Health; Reading; Reporting; Research; Research Design; Research Personnel; Risk; Role; Second Pregnancy Trimester; Statistical Data Interpretation; Stroke; Training; Validation; Woman; base; career; career development; design; evidence base; fetal; hemodynamics; high risk; hypertension treatment; men; monitoring device; mortality; multidisciplinary; overtreatment; pregnancy disorder; pregnancy hypertension; pregnant; pressure; programs; research data dissemination

PROJECT SUMMARY/ABSTRACT Dr. Natalie A. Bello is a cardiologist whose long-term career goal is to generate and disseminate empiric evidence to reduce the burden of maternal-fetal morbidity and mortality resulting from hypertensive disorders of pregnancy (HDP). She seeks a K23 Career Development Award to attain this goal, and has assembled a multidisciplinary team of senior investigators in hypertension (HTN) (Drs. Daichi Shimbo and Suzanne Oparil), out-of-clinic blood pressure (BP) measurement including home BP monitoring (HBPM) (Drs. Shimbo and Joseph Schwartz), epidemiology (Dr. Paul Muntner), maternal-fetal medicine (Drs. Alan Tita and Ronald Wapner), and biostatistics (Drs. Schwartz and Muntner). Dr. Bello’s training will consist of four modules: (1) Hypertensive Disorders of Pregnancy, (2) Research Aspects of the Diagnosis and Treatment of HTN, (3) Advanced Study Design and Statistical Analysis in HTN, and (4) Research Dissemination and Transition to Independence. HDP, including chronic and gestational HTN, are associated with substantial maternal-fetal morbidity and mortality. The accurate determination of BP in pregnant women with chronic and gestational HTN is essential, as both under- and over-treatment of HTN may result in harm to the mother and/or fetus. Traditional clinic BP (CBP), which involves a healthcare provider measuring BP, is a poor surrogate for ecological BP in the naturalistic environment. Compared to CBP, out-of-clinic BP on HBPM better estimates ecological BP, and thus may be a superior measure of placental perfusion. Although these data suggest that HBPM has an essential role in the management of chronic and gestational HTN, there are several knowledge gaps that limit the widespread use of HBPM in this population. The minimum number of days of HBPM to reliably estimate mean home BP, and the long-term adherence to HBPM during pregnancy among women with chronic and gestational HTN are unknown. Finally, studies of non-pregnant individuals show that compared to traditional CBP, CBP measured using an automated device in the absence of a healthcare provider (unattended CBP) may better approximate out-of-clinic BP. In the proposed project, the minimum number of days of HBPM needed to provide a reliable estimate of mean home BP (Primary Aim 1) and the long-term adherence to HBPM during pregnancy (Primary Aim 2) will be determined. Whether mean unattended CBP versus traditional CBP is closer to mean home BP (Secondary Aim) will also be assessed. Primary Aim 1 and Secondary Aim will be addressed among 105 pregnant women (<34 weeks gestation) with chronic and gestational HTN who will undergo HBPM for 14 days with traditional and unattended CBP measurement (Study 1). Primary Aim 2 will be addressed among 75 pregnant women with chronic and gestational HTN who will undergo HBPM daily from the second trimester (gestational week 20-26) through delivery (Study 2). These data will inform Dr. Bello’s program of research on HDP, and will provide the foundation for her to design larger outcomes-based studies (R01) examining the role of HBPM and CBP in pregnancy. 1

项目摘要/摘要 Natalie A. Bello博士是一名心脏病专家，其长期职业目标是产生和传播经验 降低孕产妇发病率和死亡率的燃烧的证据 怀孕（HDP）。她寻求K23职业发展奖来实现这一目标，并集会了 高血压高级研究人员（HTN）（Daichi Shimbo和Suzanne Oparil博士）的多学科团队， 临床外血压（BP）测量包括家庭BP监测（HBPM）（Shimbo博士和 约瑟夫·施瓦茨 Wapner）和生物统计学（Schwartz和Muntner博士）。贝洛博士的培训将包括四个模块：（1） 怀孕的高血压疾病，（2）HTN诊断和治疗的研究方面，（3） 高级研究设计和HTN中的统计分析，以及（4）研究传播和过渡到 独立。 HDP，包括慢性和妊娠HTN，与大量材料相关 发病率和死亡率。慢性和妊娠孕妇的BP准确确定 HTN是必不可少的，因为HTN的不足和过度治疗可能会对母亲和/或胎儿造成伤害。 传统诊所BP（CBP）涉及衡量BP的医疗保健提供者，对替代品很差 自然主义环境中的生态bp。与CBP相比，HBPM的临床外BP更好估计 生态BP，因此可能是对斑点灌注的优越测量。尽管这些数据表明 HBPM在慢性和妊娠HTN的管理中起着至关重要的作用，有几种知识 限制HBPM在该人群中使用宽度的差距。 HBPM的最小天数 可靠地估计平均家庭BP，以及在怀孕期间长期遵守 慢性和妊娠HTN是未知的。最后，对非怀孕个体的研究表明，与 在没有医疗保健提供者的情况下，使用自动化设备测量的传统CBP，CBP （无人看管的CBP）可以更好地近似临床外BP。在拟议的项目中，最小数量 HBPM的天数需要提供平均家庭BP的可靠估计（主要目标1）和长期 将确定怀孕期间对HBPM的依从性（主要目标2）。是否意味着无人值守的CBP 还将评估传统的CBP与传统CBP更接近于家庭BP（次要目标）。主要目标1和 次要目标将在105名孕妇（少于34周妊娠）中解决慢性和 妊娠HTN，他将通过传统和无人值守的CBP测量进行HBPM 14天（研究） 1）。主要目标2将在75名患有慢性和妊娠HTN的孕妇中解决 通过分娩（研究2），从第二个三个月（妊娠第20-26周）进行HBPM。这些 数据将为Bello博士的HDP研究计划提供信息，并将为她设计更大的基础 基于结果的研究（R01）研究了HBPM和CBP在妊娠中的作用。 1