Prognostic Implications of Home-Based Blood Pressure Monitoring in Older Adults

老年人家庭血压监测的预后意义

• 批准号: 10829528
• 负责人: STEPHEN P JURASCHEK
• 金额: $ 23.02万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-20 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10829528
• 关键词: Address; Adoption; Adult; Affect; Age; Age Years; Aged, 80 and over; Ambulatory Blood Pressure Monitoring; American; Atherosclerosis Risk in Communities; Biosensor; Blood Pressure; Blood Pressure Monitors; COVID-19; COVID-19 pandemic; Cardiovascular Diseases; Caring; Cessation of life; Clinic; Clinic Visits; Clinical; Cohort Studies; Collection; Communities; Coronavirus Infections; Data; Dementia; Devices; Diagnosis; Elderly; Event; Foundations; Frequencies; Funding; Goals; Health; Home; Home Blood Pressure Monitoring; Hour; Hypertension; Impaired cognition; Improve Access; Intervention Trial; Investments; Joints; Knowledge; Machine Learning; Measurement; Measures; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Neurocognitive; Outcome; Participant; Performance; Population; Population Heterogeneity; Practice Guidelines; Predisposition; Prospective Studies; Protocols documentation; Research; Research Personnel; Risk; Risk Factors; Role; Translations; Transportation; United States; Visit; Vulnerable Populations; aged; aggressive therapy; aging population; blood pressure control; blood pressure elevation; blood pressure intervention; blood pressure variability; clinical practice; cohort; current pandemic; dementia risk; design; digital monitoring; human old age (65+); improved; innovative technologies; modifiable risk; outcome prediction; prevent; prognostic; prognostic performance; prognostic value; racial diversity; risk prediction; risk prediction model; screening; tool; transportation access; trend; virtual

Hypertension affects over 85% of adults over 75 years of age and represents one of the few modifiable risk factors to prevent dementia and cardiovascular disease (CVD) events in older adults. However, current practice guidelines for hypertension screening and treatment focus heavily on blood pressure (BP) measurements obtained in clinic settings. This reliance on brick-and-mortar offices for BP measurement represents a significant barrier for older adults, who often depend on others for transportation and who are at increased risk of severe morbidity from the current COVID-19 pandemic. Home BP monitoring (HBPM) has shown incredible promise for more effective and timely BP treatment and control. Furthermore, the current pandemic has catalyzed widespread adoption of HBPM for hypertension screening and management. However, evidence for this practice is severely lacking in older adults. In fact, there are virtually no HBPM cohort studies in elderly populations in the United States. This is particularly concerning as the discordance between clinic and home BP increases with age, making older adults especially susceptible to harms from either overly aggressive or delayed BP treatment. In this proposed study, we apply our unique expertise with HBPM and 24-hour ambulatory blood pressure monitoring to one of the most long-standing and well-respected American cohorts of community-dwelling adults, the Atherosclerosis Risk in Communities Study (ARIC). While ARIC already rigorously measures BP in the clinic setting via automated devices, our proposal will additionally assess 8 days of HBPM and 24 hours of ambulatory BP (once every 20 minutes) in 2,142 racially diverse adults over age 80 years, establishing possibly the largest prospective study of home, ambulatory, and clinic-based BP measurement among older adults in the world. This proposal is designed to directly inform clinical practice with HBPM by characterizing its measurement performance (bias and variance), predictiveness with respect to key long-term events (dementia and CVD), and interpretation (i.e. what a home BP measure equals in terms of BP measured by ABPM or in clinic). The accomplishment of this proposal will address critical gaps in knowledge related to an increasingly utilized form of BP measurement, improving access to timely hypertension care by establishing an efficient protocol for precise BP measurement at home. Moreover, by investing in the digital monitoring platform of the ARIC study, this proposal will lay the foundation for remote collection of a wide range of detailed, longitudinal, biosensor data that can be leveraged by many investigators through subsequent ARIC proposals in years to come. With current trends in BP control worsening among older adults in the United States, there has never been a greater need for research on innovative technologies to improve access to high quality BP measurement. Ultimately, our proposal directly answers the call by NHLBI's 2017 expert panel on BP measurement for high impact research that determines “the role of ABPM and HBPM in the diagnosis…of hypertension” and “the optimal protocol for using HBPM…to diagnose and assess…hypertension.”

高血压影响超过85％的75岁以上的成年人，这代表了少数可改变的风险之一 预防老年人痴呆和心血管疾病（CVD）事件的因素。但是，当前的做法 高血压筛查和治疗指南重点关注血压（BP）测量 在诊所环境中获得。对BP测量的实体办公室的这种缓解是重要的 老年人的障碍，他们经常依靠他人进行运输，并且患有严重的风险增加 目前的Covid-19大流行病的发病率。家庭BP监控（HBPM）表现出了令人难以置信的希望 BP治疗和控制更有效，更及时。此外，当前的大流行已经催化 HBPM的宽度采用用于高血压筛查和管理。但是，这种做法的证据 老年人严重缺乏。实际上，在较老的人群中，几乎没有HBPM队列研究 美国。这尤其关注，因为随着诊所和家庭BP之间的不和谐随着 年龄，使老年人特别容易受到过度侵略性或延迟的BP治疗的伤害。 在这项拟议的研究中，我们将独特的专业知识应用于HBPM和24小时的卧床血压 监视最长期和备受尊敬的美国人群之一的社区居民， 社区研究（ARIC）的动脉粥样硬化风险。虽然ARIC已经严格测量了诊所的BP 通过自动设备设置，我们的建议还将评估8天的HBPM和24小时的卧床 BP（每20分钟一次）在80岁以上的2,142名种族多元化的成年人中，确立了最大的成年人 对全球老年人的家庭，门诊和基于诊所的BP测量的前瞻性研究。这 建议旨在通过表征其测量来直接使用HBPM临床实践为临床实践提供信息 绩效（偏见和差异），关于关键长期事件（痴呆和CVD）的预测性以及 解释（即，在ABPM或诊所测量的BP方面，家庭BP量度等于什么）。 该提案的实现将解决与越来越多地使用的知识的关键差距 BP测量的形式，通过建立有效的方案来改善及时的高血压护理的访问 精确的BP测量在家。此外，通过在ARIC研究的数字监测平台上进行投资， 该建议将为远程收集各种细节，纵向，生物传感器数据奠定基础 许多调查人员可以通过未来几年的随后的ARIC提案来利用这一点。 在美国的老年人中，当前的BP控制趋势令人担忧，从来没有 更需要研究创新技术，以改善获得高质量BP测量的机会。 最终，我们的提案直接回答了NHLBI 2017年BP测量专家小组的呼吁 影响“ ABPM和HBPM在高血压的诊断中的作用”和“高血压的作用”和“ 使用HBPM ...进行诊断和评估...高血压的最佳方案。”

项目成果

Comparison of Home and Office Blood Pressure Devices in the Clinical Setting.

家庭和办公室血压设备在临床环境中的比较。

• DOI: 10.1093/ajh/hpad120
• 发表时间: 2024
• 期刊: American journal of hypertension
• 影响因子: 3.2
• 作者: Juraschek,StephenP;Vyavahare,Medha;Cluett,JenniferL;Turkson-Ocran,Ruth-Alma;Mukamal,KennethJ;Ishak,AnthonyM
• 通讯作者: Ishak,AnthonyM

There Is No 1-Size-Fits-All to Blood Pressure Measurement-Cuff Size Matters.

血压测量没有万能的方法，袖带尺寸很重要。

• DOI: 10.1001/jamainternmed.2023.3277
• 发表时间: 2023
• 期刊: JAMA internal medicine
• 影响因子: 39
• 作者: Lalika,Mathias;Juraschek,StephenP;Brewer,LaPrincessC
• 通讯作者: Brewer,LaPrincessC

American Heart Association EPI|Lifestyle Scientific Sessions: 2022 Meeting Highlights.

• DOI: 10.1161/jaha.122.028695
• 发表时间: 2023-04-18
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Sattler, Elisabeth L. P.;Ogungbe, Oluwabunmi;Wallace, Amelia S.;Aryan, Zahra;Castilla-Ojo, Noelle;Dai, Jin;De Anda-Duran, Ileana;Foti, Kathryn;German, Charles A.;Hyde, Eric T.;Jafarian-Kerman, Scott R.;Kendrick, Karla N.;King, Ben;Lang, Adam Edward;Tang, Olive;Turkson-Ocran, Ruth-Alma;Rodriguez, Luis A.;Wang, Frances M.;Zhang, Mingyu;Hivert, Marie-France;Lutsey, Pamela L.
• 通讯作者: Lutsey, Pamela L.

Heterogeneity in Cardiovascular Disease Risk Factors Among Latino Immigrant Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey.

• DOI: 10.1161/jaha.122.027433
• 发表时间: 2023-05-16
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Elias, Sabrina;Turkson-Ocran, Ruth-Alma;Koirala, Binu;Byiringiro, Samuel;Baptiste, Diana;Himmelfarb, Cheryl R.;Commodore-Mensah, Yvonne
• 通讯作者: Commodore-Mensah, Yvonne