Clinical Implications of Blood Pressure Patterns Among Older Adults

老年人血压模式的临床意义

基本信息

批准号：
10687844
负责人：
STEPHEN P JURASCHEK
金额：
$ 74.26万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
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：
2021-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10687844
关键词：
Address Adoption Adult Adverse event Affect Age Age Years Aged, 80 and over Aging Ambulatory Blood Pressure Monitoring American Antihypertensive Agents Atherosclerosis Risk in Communities Biological Markers Blood Pressure Blood Screening Brain natriuretic peptide Cardiac Cardiovascular Diseases Cardiovascular system Clinic Clinical Collaborations Communities Congestive Heart Failure Coronary heart disease Dementia Diagnosis Disease Pathway Elderly Equilibrium Event Exclusion Funding Gait Gait speed Goals Guidelines Heart Injuries Home Hospitalization Hour Hypertension Hypotension Hypotensives Impaired cognition Injury Intervention Trial Investments Israel Knowledge Measurement Measures Medical center Mentored Patient-Oriented Research Career Development Award N-terminal National Heart, Lung, and Blood Institute Natriuretic Peptides Neurocognitive Orthostatic Hypotension Participant Pathway interactions Pattern Phenotype Physical Function Physical Performance Physical assessment Population Population Heterogeneity Predisposition Prevalence Prospective Studies Protocols documentation Reaction Time Recommendation Recurrence Research Research Personnel Role Specimen Stroke Supination Time Troponin T United States Visit Visuospatial Vulnerable Populations Work aging population awake blood pressure control blood pressure intervention blood pressure reduction cardiovascular risk factor cognitive function cohort fall risk falls follow-up healthy aging heart damage hypertension treatment middle age modifiable risk overtreatment prevent processing speed treatment strategy

项目摘要

Hypertension affects nearly 100% of adults over 75 years of age, and the recent Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that targeting lower clinic-based blood pressure (BP) measurements prevented cardiovascular disease (CVD) events in older adults. However, hypotension-related hospitalizations were among the most significant complications from intensive BP treatment, despite SPRINT's carefully executed BP measurement protocols. The inability of clinic-based BP to predict hypotensive complications has led many to question whether lower BP treatment goals based on clinic BP alone are safe in older adults, who are especially vulnerable to perceived consequences of hypotension, like falls and dementia. While guidelines recommend that BP treatment be informed by standing clinic-based BP measurements and 24-hour ambulatory blood pressure monitoring (ABPM) outside of clinic, the prevalence and long-term implications of (1) low BP upon standing (i.e. orthostatic hypotension [OH]) and (2) large discrepancies between clinic and home BP (“white coat effects” [WCE]) are under-characterized among older adults. In this study, we apply our unique expertise with OH assessments and 24-hour ambulatory blood pressure monitoring (ABPM) to one of the most long-standing and well-respected American cohorts of community-dwelling adults, the Atherosclerosis Risk in Communities Study (ARIC). Our proposal will assess OH and ABPM in 2,345 black and white adults over age 80 years, establishing possibly the largest prospective study of both OH and WCE among older adults in the United States. Our aims are to quantify the prevalence of OH and WCE in this diverse population and determine the association of OH and WCE with longitudinal change in (1) physical function (balance, gait speed, gait pattern), (2) cognitive function (response time, visuospatial domains), and (3) highly sensitive markers of subclinical cardiac injury and strain, high sensitivity cardiac troponin T and N terminal b-type pro natriuretic peptide. Moreover, we will establish the association of OH and WCE with clinical events related to hypotension – falls, dementia, and CVD – over nearly four years of follow-up. Finding that OH and WCE in older adults are not associated with falls, dementia, and CVD would challenge current recommendations to screen for these BP patterns prior to BP treatment initiation or intensification, mitigating delays to treatment. However, finding that OH and WCE are prevalent and associated with falls, dementia, and CVD through our comprehensive measurement protocols would inform best practices for these assessments prior to treatment initiation and intensification to avoid adverse events among vulnerable adults. This proposal will inform guidelines for BP management by filling critical gaps in knowledge related to two BP patterns that are often cited as reasons to defer intensive therapy in older adults. Ultimately, our proposal directly answers the call by NHLBI's 2017 expert panel on BP measurement for high impact research that determines: (1) “the value of using orthostatic hypotension” and (2) “the role of ABPM…[in the] treatment of hypertension.”

高血压影响近 100% 75 岁以上的成年人，最近的收缩压干预试验 (SPRINT) 证明目标是降低临床血压 (BP) 测量值预防老年人心血管疾病（CVD）事件然而，低血压相关的住院治疗。尽管 SPRINT 小心谨慎，但 BP 治疗仍是强化血压治疗最显着的并发症之一执行血压测量方案基于临床的血压无法预测低血压并发症。导致许多人质疑仅基于诊所血压的较低血压治疗目标对于老年人是否安全，他们尤其容易受到低血压的影响，例如跌倒和痴呆。建议通过站立临床血压测量和 24 小时动态血压来了解血压治疗诊所外血压监测 (ABPM)、(1) 低血压的患病率和长期影响站立时（即体位性低血压 [OH]）和 (2) 诊所血压和家庭血压之间存在巨大差异（“白外套效应”[WCE]）在老年人中未被充分表征。在这项研究中，我们运用了 OH 评估和 24 小时动态血压方面的独特专业知识对美国历史最悠久、最受尊敬的社区居民群体之一进行监测 (ABPM) 社区动脉粥样硬化风险研究 (ARIC) 我们的提案将评估 2,345 名成年人的 OH 和 ABPM。 80 岁以上的黑人和白人成年人，建立了可能是 OH 和 OH 的最大前瞻性研究我们的目标是量化美国老年人中 OH 和 WCE 的患病率。不同人群并确定 OH 和 WCE 与 (1) 身体素质纵向变化的关系功能（平衡、步态速度、步态模式），(2) 认知功能（反应时间、视觉空间域），以及 (3) 亚临床心脏损伤和劳损的高灵敏标记物、高灵敏心肌肌钙蛋白 T 和 N 末端此外，我们将建立 OH 和 WCE 与临床事件的关联。在近四年的随访中，我们发现了与低血压相关的疾病——跌倒、痴呆和心血管疾病。发现老年人的 OH 和 WCE 与跌倒、痴呆和 CVD 无关，这将是一项挑战目前建议在开始或强化血压治疗之前筛查这些血压模式，减少治疗延误然而，发现 OH 和 WCE 很普遍并且与跌倒有关，通过我们全面的测量协议，痴呆症和心血管疾病将为这些疾病提供最佳实践在开始和强化治疗之前进行评估，以避免弱势成年人发生不良事件。该提案将为 BP 管理提供指导方针，填补与两个 BP 相关的知识的关键空白经常被引用为推迟老年人强化治疗的原因的模式最终，我们的建议是直接的。响应 NHLBI 2017 年高影响力研究血压测量专家小组的号召，该小组确定： (1)“使用直立性低血压的价值”和(2)“ABPM 的作用……[在]治疗高血压中”。

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Standing Blood Pressure and Risk of Falls, Syncope, Coronary Heart Disease, and Mortality.

站立血压与跌倒、晕厥、冠心病和死亡的风险。

DOI：
发表时间：
2023-10-13
期刊：
影响因子：
3.2
作者：
Kondo, Jordan K;Earle, William B;Turkson;Ngo, Long H;Cluett, Jennifer L;Lipsitz, Lewis A;Daya, Natalie R;Selvin, Elizabeth;Lutsey, Pamela L;Coresh, Josef;Windham, Beverly Gwen;Kendrick, Karla N;Juraschek, Stephen P
通讯作者：
Juraschek, Stephen P

Management of Patients With Hypertension and Orthostatic Hypotension. Parallel Progress.

高血压和直立性低血压患者的管理。

DOI：
发表时间：
2022-11
期刊：
影响因子：
0
作者：
Juraschek, Stephen P;Biaggioni, Italo
通讯作者：
Biaggioni, Italo

International Consensus on Standardized Clinic Blood Pressure Measurement - A Call to Action.

标准化临床血压测量国际共识 - 行动呼吁。

DOI：
发表时间：
2023-05
期刊：
影响因子：
0
作者：
Cheung, Alfred K;Whelton, Paul K;Muntner, Paul;Schutte, Aletta E;Moran, Andrew E;Williams, Bryan;Sarafidis, Pantelis;Chang, Tara I;Daskalopoulou, Stella S;Flack, John M;Jennings, Garry;Juraschek, Stephen P;Kreutz, Reinhold;Mancia, Giuseppe;N
通讯作者：
N

The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring.

连续无袖血压监测的承诺与幻想。

DOI：
发表时间：
2023-10
期刊：
影响因子：
3.7
作者：
Hu, Jiun;Park, Dae Yong;Agarwal, Nikita;Herzig, Matthew;Ormseth, George;Kaushik, Milan;Giao, Duc M;Turkson;Juraschek, Stephen P
通讯作者：
Juraschek, Stephen P

Potassium: To Add or to Replace…That Is the Question.

钾：添加还是替代——这就是问题所在。