Home blood pressure and falls among older adults

老年人的家庭血压和跌倒情况

• 批准号: 10403687
• 负责人: Emily B Levitan
• 金额: $ 38.29万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10403687
• 关键词: Adult; Age-Years; Ambulatory Blood Pressure Monitoring; Ancillary Study; Antihypertensive Agents; Blood Pressure; Blood Pressure Monitors; California; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Cessation of life; Characteristics; Clinic; Clinical; Data; Elderly; Electronic Health Record; Enrollment; Environment; Equilibrium; Event; Funding; Geriatric Assessment; Goals; Gold; Guidelines; Health Personnel; Health system; Healthcare; Home; Home Blood Pressure Monitoring; Hospitalization; Hour; Hypertension; Individual; Injury; Inpatients; Knowledge; Measurement; Measures; Outpatients; Participant; Patients; Persons; Pharmaceutical Preparations; Predictive Value; Procedures; Prospective cohort study; Public Health; Randomized Controlled Trials; Research; Rest; Risk; Risk Reduction; Role; Techniques; Time; United States National Institutes of Health; Visit; base; blood pressure control; blood pressure variability; cardiovascular disorder risk; cardiovascular risk factor; clinical practice; cost; cost efficient; design; experience; fall injury; fall risk; falls; follow-up; high risk; human old age (65+); improved; personalized care; predict clinical outcome; prognostic; routine care

Cardiovascular disease (CVD) is the leading cause of death among older US adults. Over 75% of US adults ≥ 65 years of age have hypertension, a major risk factor for CVD. Randomized controlled trials have demonstrated that lowering blood pressure (BP) through antihypertensive medication reduces the risk for CVD by 20% to 40% among older adults with hypertension. Many older US adults have uncontrolled BP and may receive CVD risk reduction benefits from intensifying their antihypertensive medication. However, clinicians are often concerned that intensively lowering BP may increase the risk for a fall. Falls are the leading cause of injury-related hospitalization and death among older US adults and more than one in three US adults ≥ 65 years of age experience a fall each year. BP has traditionally been measured in the clinic setting and a major challenge that clinicians encounter in deciding to titrate antihypertensive medication is the inaccuracy of BP assessed in this setting. Home blood pressure monitoring (HBPM) is an inexpensive and highly feasible approach to measure BP outside of the clinic setting and has the potential to improve BP control and, therefore, reduce CVD risk. Whether HBPM can identify patients for whom antihypertensive medication can be intensified without increasing the risk for a fall is unknown. A newly NIH-funded (July 1, 2018 to June 30, 2022) prospective cohort study (AMBulatoRy blOod preSsure In older Adults [AMBROSIA]) will evaluate the association of BP, measured outside of the clinic setting using ambulatory blood pressure monitoring (ABPM), with falls risk among 1,057 adults aged ≥ 65 years, taking antihypertensive medication from the Kaiser Permanente Southern California (KPSC) health system. ABPM was chosen for the AMBROSIA study as it is considered the gold-standard approach for assessing out-of-clinic BP. Compared to ABPM, HBPM is more widely available in the US and better tolerated by patients. The AMBROSIA study is not funded to perform HBPM. The overall goal of the proposed ancillary study to AMBROSIA is to determine whether BP on HBPM can identify older adults taking antihypertensive medication who are at increased risk for falls, and whether HBPM provides similar predictive value for falls when compared with ABPM. AMBROSIA will begin study visits in February 2019 and the proposed ancillary study (AMBROSIA-HOME) will add the conduct of HBPM for 7 days, with two BP measurements obtained in the morning and two BP measurements obtained in the evening on each day, following the conduct of ABPM for 1,000 participants. Conducting the AMBROSIA-HOME study will be cost-efficient as information on demographic and clinical characteristics, geriatric assessments, research-grade BP measurements, and 24-hour ABPM is already being collected at baseline with falls and serious fall injuries being assessed during a one-year follow-up period. The AMBROSIA-HOME study will provide valuable data on the role of HBPM to personalize care for older adults taking antihypertensive medication.

心血管疾病 (CVD) 是美国老年人死亡的主要原因，超过 75% 的美国成年人死亡。 65岁患有高血压，这是CVD的主要危险因素。 证明通过抗高血压药物降低血压（BP）可降低心血管疾病的风险 患有高血压的老年人的血压升高了 20% 至 40%。 通过加强抗高血压药物治疗获得降低 CVD 风险的益处。 人们经常担心强烈降低血压可能会增加跌倒的风险。 美国老年人和超过三分之一的 ≥ 65 岁美国成年人中因伤害而住院和死亡的人数 传统上，血压每年都会在诊所和专业机构中测量一次。 殖民者在决定滴定抗高血压药物时遇到的挑战是血压不准确 在这种情况下进行评估的家庭血压监测（HBPM）是一种廉价且高度可行的方法。 在诊所外测量血压的方法，有可能改善血压控制， 因此，HBPM 是否可以识别可以使用抗高血压药物的患者。 NIH 新资助的（2018 年 7 月 1 日至 2022 年 6 月 30 日）未知。 前瞻性队列研究（老年人的 AMBulatoRy 血压 [AMBROSIA]）将评估 血压的关联，在诊所外使用动态血压监测（ABPM）进行测量， 1,057 名年龄 ≥ 65 岁的成年人中有跌倒风险，服用 Kaiser 降压药物 南加州永久医疗机构 (KPSC) 卫生系统被选为 AMBROSIA 研究的对象。 与 ABPM 相比，HBPM 被认为是评估临床外血压的黄金标准方法。 AMBROSIA 研究在美国广泛使用且患者耐受性更好。 HBPM。拟议的 AMBROSIA 辅助研究的总体目标是确定 BP 是否影响 HBPM。 可以识别服用抗高血压药物的老年人跌倒风险增加，以及是否 与 ABPM 相比，HBPM 对跌倒具有相似的预测价值 AMBROSIA 将开始研究访问。 2019 年 2 月，拟议的辅助研究 (AMBROSIA-HOME) 将添加 HBPM 的实施时间为 7 天，早上获得两次血压测量值，晚上获得两次血压测量值 每天，对 1,000 名参与者进行 ABPM 后进行 AMBROSIA-HOME 研究。 作为有关人口和临床特征、老年评估的信息，将具有成本效益， 研究级血压测量，以及 24 小时 ABPM 已在基线时收集跌倒和 AMBROSIA-HOME 研究将在一年的随访期间对严重跌倒伤害进行评估。 提供有关 HBPM 在为服用抗高血压药物的老年人提供个性化护理方面的作用的宝贵数据 药物。