A New Paradigm for Hypertension in the Elderly- Beyond Age

老年人高血压的新范式——超越年龄

基本信息

批准号：
9519485
负责人：
Michelle Christina Odden
金额：
$ 16.31万
依托单位：
NORTHERN CALIFORNIA INSTITUTE/RES/EDU
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2018-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9519485
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 Individual Latino 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 blood pressure reduction cardiovascular health cardiovascular risk factor clinical practice cohort design evidence base functional status high risk improved learning strategy middle age mortality novel public health relevance systolic hypertension treatment effect

项目摘要

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（由申请人提供）：超过 60% 的 65 岁以上成年人患有高血压 (BP)，但对老年人高血压的最佳管理仍存在争议，与中年证据表明降低血压明显有益。在老年人中是不一致且高血压可能不是所有老年人的危险因素我们最近报道，在国家健康和营养检查调查年龄 65 岁以上的参与者中，高血压仅是全因死亡和心血管 (CV) 死亡的危险因素。在健康状况较好的人中（定义为 20 英尺步行测试中的快速步行），相比之下，对于慢速步行者来说，高血压并不是一个危险因素。此外，降低血压对所有老年人的益处仍然存在争议。最近的对 80 岁及以上人群的荟萃分析表明，血压治疗对死亡率没有益处，而且试验之间存在显着的异质性。最后，人们越来越担心过度降低血压（尤其是舒张压）可能带来的危害。在一些研究中，血压与死亡和心血管事件的风险增加有关，我们提出了一种新的范式，在复杂的衰老过程中考虑了血压与老年人不良后果的关系。术语目标是通过定义相似健康状况的亚群，可靠地识别血压治疗有益的老年人和治疗无效甚至有害的老年人。具体而言，目标 1 提出阐明四个领域（功能、认知/心理、自我认知）的因素。使用来自 NIH 资助的三个队列的数据，可以识别高收缩压与较高死亡和心血管事件风险密切相关的老年人以及与此无关的老年人：健康研究 (CHS)、健康老龄化和身体成分 (Health ABC) 以及萨克拉门托地区拉丁裔老龄化研究 (SALSA) 在目标 2 中，我们将根据健康状况水平评估舒张压的作用。在目标 3 中，我们将评估这些观察队列是否可以通过两项随机对照试验（老年人收缩期高血压 (SHEP) 和老年人收缩期高血压的二级预防）来确定降压治疗对老年人有最大益处。由于试验参与者比美国人口更健康，我们还将使用最先进的因果推理方法来评估观察性研究中的治疗效果，这可以纠正偏倚标准分析方法的完成将大大提高我们对老年人高血压重要性的认识；将提高我们识别哪些老年人将从高血压治疗中受益的能力；治疗是缺乏；并将指导未来老年人高血压试验的设计。