HIV, Sleep, Nocturnal Non-dipping, and Cardiovascular Disease: a Tanzanian Cohort

HIV、睡眠、夜间非浸渍和心血管疾病：坦桑尼亚队列

基本信息

批准号：
10672285
负责人：
Robert N Peck
金额：
$ 54.41万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-20 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10672285
关键词：
Adult Africa Age Albuminuria Ambulatory Blood Pressure Monitoring Antihypertensive Agents Biometry Blood Pressure Cardiology Cardiovascular Diseases Caring Cessation of life Chronic Clinical Trials Cohort Studies Collaborations Cross-Sectional Studies Data Disease Diurnal Rhythm Dose Epidemic Epidemiology Equation Etiology Event Family Foundations Functional disorder Future Gender Goals Guidelines HIV HIV Infections Health Heart failure Hospitals Hour Hypertension Incidence Inflammation Insulin Resistance Intervention Intervention Trial Knowledge Laboratories Left Left Ventricular Mass Longitudinal Studies Measures Medicine Modeling Monitor Morbidity - disease rate Myocardial Infarction Natural History Oxygen saturation measurement Participant Pathway interactions Persons Premature Mortality Prevalence Prevention Renin Renin-Angiotensin System Research Risk Factors Science Sleep Sleep Disorders Stroke Sympathetic Nervous System Tanzania Testing Time Time trend United States United States National Institutes of Health Universities Ventricular actigraphy arterial stiffness blood pressure elevation blood pressure medication cardiovascular disorder risk cohort comparative cost design falls heart rate variability mortality novel poor sleep portability pre-clinical premature prevent sleep health vascular inflammation

项目摘要

ABSTRACT: The incidence of cardiovascular disease (CVD) in people with HIV (PWH) is ~2.5-fold higher than among HIV-uninfected adults of similar age. HIV-attributable CVD risk is highest in Africa. Ambulatory blood pressure (ABP) monitoring with a portable cuff worn for 24 hours provides mean daytime and nighttime blood pressures and detects abnormalities in the diurnal variation of blood pressure such as nocturnal non-dipping, which is defined by the absence of the 10% usual fall (dip) in blood pressure at night. ABP more accurately predicts CVD events than office blood pressure. Elevated nighttime blood pressure and non-dipping may contribute to the excess CVD risk in PWH. Small, cross-sectional studies suggest that non- dipping is more common in PWH and may be associated with CVD. The long-term goal is to reduce CVD morbidity and mortality in PWH. The study objectives are to 1) compare the time course of non-dipping and resulting preclinical CVD in PWH vs. HIV-uninfected adults and 2) to identify potential pathophysiologic pathways that could be targets for future intervention. We propose a comparative cohort study of PWH and HIV-uninfected adults with repeated measures of ABP, sleep, SNS activity and preclinical CVD to be conducted in an established cohort of 500 PWH and 500 HIV-uninfected adults in Tanzania. Aim 1: To determine the prevalence of confirmed non-dipping and its association with incident preclinical CVD after 36 months in a cohort of 500 PWH on stable ART and 500 matched HIV-uninfected adults (age >30 years) in Tanzania. ABP will be performed at baseline and then repeated at 1 month. Preclinical CVD will be quantified at baseline and after 18 and 36 months. Incidence of CVD events will also be monitored. We will also examine other ABP abnormalities in relationship to preclinical CVD. Aim 2: To determine the temporal relationship between sleep disorders, SNS activity and non-dipping and whether this differs by HIV status or gender. We will quantify sleep and SNS activity at baseline and after 18 and 36 months on all participants. We will also investigate the renin-angiotensin system, insulin resistance and chronic inflammation as potential pathways leading to non-dipping. We will also compare temporal trends in sleep and SNS activity between PWH and HIV-uninfected adults. The proposed research will be the first longitudinal study of ABP and sleep disorders in Africa and will directly inform HIV-specific and general guidelines. We will also lay groundwork for a mechanistic clinical trial to test a novel, low-cost strategy targeting ABP abnormalities to prevent CVD in PWH.

摘要：艾滋病毒（PWH）患者心血管疾病（CVD）的发生率高约2.5倍在艾滋病毒未感染的成年人中，年龄相似。在非洲，HIV-Atibutable CVD风险最高。卧床血压（ABP）用便携式袖口磨损24小时监测可提供平均白天和夜间血压和检测血压昼夜变化的异常夜间非浸泡，这是由晚上血压中缺乏10％的通常跌落（降低）来定义的。与办公室血压相比，ABP更准确地预测CVD事件。夜间血压升高非浸润可能会导致PWH中过量的CVD风险。小型的横截面研究表明，非浸入在PWH中更常见，可能与CVD有关。长期目标是减少CVD PWH中的发病率和死亡率。研究目标是1）比较非浸水的时间过程和 PWH与HIV未感染的成年人和2）临床前CVD识别潜在的病理生理学可能是将来干预的目标的途径。我们提出了PWH和PWH的比较队列研究艾滋病毒未感染的成年人反复衡量ABP，睡眠，社交媒体活动和临床前CVD 在坦桑尼亚的500 PWH和500名HIV未感染的成年人中进行的队列进行。目的1：确定已确认的非浸泡的患病率及其与事件的关联临床前CVD在36个月后，在500 PWH的队列中，稳定艺术和500匹配的HIV未感染坦桑尼亚的成人（> 30岁）。 ABP将在基线时进行，然后在1个月重复。临床前CVD将在基线和18和36个月后进行量化。 CVD事件的发病率也将是受监控。我们还将检查与临床前CVD关系的其他ABP异常。目标2：确定睡眠障碍，社交媒体活动和非浸入之间的临时关系以及艾滋病毒状况的这种差异还是性别。我们将在基线时量化睡眠和SNS活动在所有参与者的18和36个月后。我们还将研究肾素 - 血管紧张素系统，胰岛素阻力和慢性感染是导致非浸泡的潜在途径。我们还将比较 PWH和艾滋病毒未感染的成年人之间睡眠和社交媒体活动的临时趋势。拟议的研究将是非洲ABP和睡眠障碍的首次纵向研究，并将直接告知特定艾滋病毒和一般指南。我们还将为机械临床试验奠定基础，以测试A 针对ABP异常的新型低成本策略以防止PWH中的CVD。