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

• 批准号: 10326723
• 负责人: Robert N Peck
• 金额: $ 61.37万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 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/10326723
• 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; Diurnal Rhythm; Dose; Epidemic; Epidemiology; Equation; Etiology; Event; Family; Foundations; Functional disorder; Future; Gender; Goals; Guidelines; HIV; 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; Premature Mortality; Prevalence; Prevention; Renin; Renin-Angiotensin System; Research; Risk; Risk Factors; Science; Sleep; Sleep Disorders; Stroke; Structure; Sympathetic Nervous System; Tanzania; Testing; Time; Time trend; United States; United States National Institutes of Health; Universities; Ventricular; actigraphy; arterial stiffness; 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; sleep onset; vascular inflammation

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：艾滋病毒感染者 (PWH) 的心血管疾病 (CVD) 发病率高出约 2.5 倍 非洲的艾滋病毒所致心血管疾病风险最高。 使用 24 小时佩戴的便携式袖带进行动态血压 (ABP) 监测，提供平均白天血压 和夜间血压，并检测血压的昼夜变化异常，例如 夜间非下降，定义为夜间血压没有出现 10% 的正常下降（下降）。 ABP 比夜间血压升高和夜间血压更准确地预测 CVD 事件。 小型横断面研究表明，非浸渍可能会增加感染者的 CVD 风险。 浸渍在产后出血者中更为常见，可能与 CVD 相关。长期目标是减少 CVD。 研究目的是 1) 比较非浸渍和浸渍的时间进程。 由此产生的 PWH 与未感染 HIV 的成人的临床前 CVD 的结果，以及 2) 确定潜在的病理生理学 我们建议对 PWH 和 PWH 进行一项比较队列研究。 重复测量 ABP、睡眠、SNS 活动和临床前 CVD 的未感染 HIV 的成年人 该研究在坦桑尼亚的 500 名艾滋病毒感染者和 500 名未感染艾滋病毒的成年人中进行。 目标 1：确定已确认的未浸渍的发生率及其与事件的关联 500 例接受匹配的稳定 ART 治疗的 PWH 和 500 例未感染 HIV 的队列 36 个月后出现临床前 CVD 坦桑尼亚的成人（年龄 > 30 岁）将在基线时进行 ABP，然后在 1 个月时重复。 将在基线时对临床前 CVD 进行量化，并在 18 个月和 36 个月后对 CVD 事件的发生率进行量化。 我们还将检查与临床前 CVD 相关的其他 ABP 异常。 目标 2：确定睡眠障碍、SNS 活动和非浸渍之间的时间关系 以及这是否因艾滋病毒状况或性别而异。我们将量化基线和社交网络活动。 18 个月和 36 个月后，我们还将调查所有参与者的肾素-血管紧张素系统、胰岛素。 抵抗力和慢性炎症是导致不浸渍的潜在途径。 艾滋病毒感染者和未感染艾滋病毒的成年人之间睡眠和社交网络活动的时间趋势。 拟议的研究将是非洲第一个关于 ABP 和睡眠障碍的纵向研究，并将直接 我们还将为测试艾滋病毒的机制临床试验奠定基础。 针对 ABP 异常以预防感染者 CVD 的新颖、低成本策略。